EMS is called to a VA clinic for a 23 year old male who came in to get checked into the system. Somewhere in the exchange, he mentioned that he had been experiencing chest pain off & on for just over a month.
Onset: Today's pain came on gradually.
Provoke: Nothing makes the pain better or worse.
Quality: Pain described as "pressure".
Radiate: Occasionally radiates to the jaw.
Severity: "Mild" (no pain scale)
Time: Several previous episodes over the past month.
The patient denies shortness of breath. There is no nausea and the patient has not vomited.
A 12-Lead ECG is captured at the clinic.
And another.
9-1-1 was contacted.
The patient was given O2, ASA, and NTG at the clinic.
EMS arrives and performs their own assessment.
(Vital signs not available -- let us assume they are within normal limits, stable, and not otherwise helpful to the assessment).
The cardiac monitor is attached.
The paramedics capture their own 12-lead ECG.
Are you concerned about this ECG?
Why or why not?
Should a STEMI Alert be called from the field?
Why or why not?
Would you bypass the local non-PCI hospital for a STEMI receiving hospital?
Why or why not?
*** Update 03/25/2010 ***
Here are some serial ECGs captured in the field.
Does this help?
