Wednesday, 4 August 2010

54 year old male CC: Chest pain

Here's an interesting case submitted by Terry Weatherford, NREMT-P.

EMS responds to a report of a 54 year old male complaining of chest discomfort.

O—Sudden onset
P—Nothing made the pain better or worse
R—Radiated to left shoulder
T—Less than 30 minutes

Vital signs:

B/P 110/78
Pulse ox 100% with O2.

S—Nausea no vomiting
M—NTG, Lisinopril, Insulin
P—MI with stents placed, diabetes and HTN
L—Breakfast 1 hr ago
E—Taking a shower

The patient informs paramedics that his pain resolved prior to EMS arrival. He states that he does not want to go to the hospital because he knows they will keep him for 4 to 5 hours and it will turn out to be nothing.

A 12-lead ECG is captured.

The paramedics tell the patient that with his past medical history he should go to the hospital by ambulance for an evaluation. He adamantly refused treatment even with 3 paramedics explaining the possible consequences of refusing care.

Suddenly, the patient's chest pain returns. He appears diaphoretic.

A second 12-lead ECG is captured.

What is your impression?