Wednesday, 26 May 2010

41 year old male CC: Chest pain

A 41 year old male is pulled over during morning rush-hour by sheriff's deputies.

He states that he is on his way to the hospital because he is having chest pain. EMS is called to the scene.

The patient is awake, alert, and oriented to person, place, time, and event.

His skin is pink, warm, and moist.

He appears acutely ill and anxious.

He states that he has a history of high blood pressure and renal insufficiency. He takes several medications, but he can only recall that one of them is a beta blocker.

Onset: 1 hour ago while sleeping.
Provoke: Nothing makes the pain better or worse.
Quality: Patient describes the pain as a poorly localized "fullness" or "pressure".
Radiate: The patient cannot tell whether or not the pain radiates.
Severity: The patient reluctantly gives the pain a 7/10.
Time: The patient states he has had the pain on several occasions over the past few months but did not seek medical treatment.

Vital signs are assessed.

Resp: 20
Pulse: 76
BP: 138/78
SpO2: 99 on RA

The cardiac monitor is attached.

A 12-lead ECG is captured.

What is your analysis of this ECG?

Does anything about it concern you?

Is this a STEMI?

Why or why not?

Note: This 12-lead ECG was captured in the back of an ambulance with the motor and generator running, but it shows excellent data quality.