Thursday, 6 January 2011

76 year old male CC: "Possible MI"

Here is a case submitted by a faithful reader from the UK who wishes to remain anonymous.

Call is received into control via 999 from a General Practitioners Surgery. Call is received as 76 year old male with possible MI.

Presenting Complaint - Chest Pain

History of Present Complaint - 76 year old male, nil cardiac history, known COPD, ex smoker, social drinker.

Awoken at 2 a.m by an acute central chest pain radiating to his left arm.

Male waited till surgery opened and made an emergency appointment.

GP had 12-lead ECG done on patient - noticed ST-elevation and administered 1x400mcg GTN spray SL, 300mg Aspirin PO and O2 therapy. Ambulance contacted via 999.

Here is the first 12-lead ECG taken by the GP.



The second 12-lead ECG taken by the GP was after NTG.



Ambulance..

On Arrival - Patient supine on bed, O2 therapy via NRB administered by GP

On examination:
Alert, orientated and communicable (GCS 15)
Slightly pale
Nil diaphoresis

Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 20, SpO2 99% on O2

H/R 89 and regular, BP 149/99

Pyrexial 37.7
B.M 10.6

C/O chest pain..
O - Acute
P - Not affected by breathing. Eases slightly leaning forward. Pain++ on palpation of sternum.
Q - Sharp in chest
R - Central chest radiating left arm
S - Pain score 7/10 eases slightly with GTN
T - 11 hours ago
I - No pain intervention sought.

Nil nausea, nil vomit

Meds - Usual COPD drugs
PMH - COPD
Allergies - NKA

Paramedics switched the patient over to their 12-lead ECG monitor.



What's going on with this patient?

What is your treatment plan?

Where would you transport this patient?

Is there anything unusual about this case?