Inferior & Right-Side STEMI

Vital signs for patient:

Initial EKG:
Initial 12-Lead: Note at bottom should state "Q-wave: Lead III"

12-Lead with v3R & v4R:
Second Right-sided 12-lead:

ST-Elevation in leads II, III, aVF, & v4R
ST-Depression in v2(probably indicating posterior MI), lead I & aVL

History of Present Illness:
Upon arrival the patient was laying in bed with chest pain. She stated that the pain started at 8 in the evening. She has no cardiac history. The patient's initial 12-lead indicated inferior wall MI, STEMI alert was called. Right-sided 12-lead showed possible Right Ventricular extension. Nitrates were withheld. The patient remained slightly hypotensive during transport with rise in BP just prior to arrival at ER. Verbal report given to ER RN, and care transferred.

AMI confirmed at ER, and patient taken to Cath-Lab.

According to PCR the patient's pain was 10 out of 10 the entire time.

Prehospital Interpretation:
23:37 12-Lead ECG: 1st degree AVB, inferior wall MI, elevation in 2, 3, AVF & V6. S-T Depression in 1, AVL, V2 & V3
23:39 12-Lead ECG: 1st Degree AV Heart Block, S-T elevation in 2, 3, AVF, V6 & V4R

Prehospital Medications:
23:38 AT Aspirin (ASA) Oral 324 MG, Unchanged
23:39 SF Oxygen (non-rebreather mask) NRB/PRB 10 LPM, Unchanged
23:45 AT Normal Saline Intravenous 250 ML, Improved

Response Times:
Dispatched : 23:25
En Route: 23:27
Arrived On Scene: 23:35
Transport: 23:43
Transport Arrived: 2359

Total time on scene: 8 minutes
Total time with patient: 24 minutes
Time from dispatch to transfer of care: 34 minutes


Rogue Medic said...

Nicely documented.

From the vital signs, it appears that the patient was gradually improving during the time recorded. What treatments were delivered? Did the patient presentation match the automated vital signs?

Adam Thompson, EMT-P said...

It's hard to buy a 40 point increase in the SBP within 4 minutes. I'm going to have to look at my trip sheet to see when I got the fluid bolus started.

I know I veered away from nitrates. I believe all that was given was O2, ASA, & NS.

I will update the post after I check my trip sheet.