Thursday, 25 March 2010

23 year old male CC: Chest Pain

Here's a fascinating case submitted by Geoff Dayne.

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?