Monday, 13 December 2010

69 year old male CC: Chest pain

Christopher A. Watford from the My Variables Only Have 6 Letters blog has submitting a very interesting case study (actually he submitted two but you'll have to wait for the other one).

EMS is called to the residence of a 69 year old male complaining of chest pain.

On arrival the patient is found sitting in a kitchen chair.

He appears acutely ill.

Skin is ashen, cool, and very diaphoretic.

Levine's sign is present.

It is obvious that the patient is anxious and in severe pain.

Onset: Sudden onset approx 20 minutes before EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: Severe pressure
Radiate: The pain does not radiate
Severity: 10/10
Time: No previous episodes

Breath sounds are clear bilaterally.

Vital signs are assessed.

RR: 20
Pulse: 60 R
BP: 142/68
SpO2: 90 on RA (increases to 96 with oxygen via NRB @ 15 LPM)

BGL: 104

No known drug allergies.
Denies any significant medical history other than "indigestion".

The cardiac monitor is attached.



A 12-lead ECG is captured.



Another 12-lead ECG is captured with modified chest leads V4R, V5R and V6R.



How would you treat this patient?

Is there anything about this case that surprises you?