96 y/o Female Near Syncope

Thank you to Jason for the invite to post on this site. If you don;t know me, I am the creator of Paramedicine 101. I am a paramedic with Lee County FL and an EMS educator with the local college. I will drop by here to provide interesting ECGs from time to time. This is one from the Paramedicine 101 archive.

As you arrive, the patient is sitting on the ground. She states that she felt weak, so she sat down. She did not lose consciousness and appears atraumatic.

S - Feels weak

A - PCN

M - Atenolol, Lasix, ASA

P - She thinks she may have had a "mild heart attack" in the past, HTN.

L - Coffee

E - She has not done any strenuous activity. She is at home, and was heading to the kitchen.

No chest pain, mild dyspnea with exertion.

12-Lead:

Please provide your impressions.

26 year old male CC: Chest pain

Here's a great case submitted by a faithful reader who wishes to remain anonymous.

EMS is called to a 26 year old male complaining of chest pain.

On arrival patient is found sitting on his living room couch. He appears anxious and acutely ill.

He states that he was riding his bike when he became anxious, had a "coughing spell" and started to experience chest discomfort. The location of the chest discomfort is in the center of his chest and slightly to the left.

Onset: Sudden while riding a bike

Provoke: Nothing makes the pain better or worse

Quality: Difficult to describe but with prompting the patient calls it "pressure"

Radiate: Left jaw and left arm

Severity: 7/10

Time: No previous episodes

The patients skin is warm and moist. The color is normal.

The patient denies shortness of breath. Breath sounds are clear bilaterally.

He is nauseated but he has not vomited.

Past medical history: Healthy

Medications: None

Vital signs are assessed.

Resp: 22

Pulse: 98

BP: 140/84

SpO2: 100 with oxygen via NRB @ 15 LPM

The cardiac monitor is attached.

A 12-lead ECG is captured.

What is your impression?

*** Update 05/14/2010 ***

The importance of serial ECGs cannot be over-emphasized.

In this case, a second 12-lead ECG was captured just prior to arrival at the hospital.

Does this new information shed any light on the probably diagnosis?

What else could you have done?