58 year old female CC: Chest pain

Here's another case study from an international reader who wishes to remain anonymous.

Presenting Complaint - Chest Pain

History of Present Complaint - 58 year old female, nil cardiac history, mild smoker, social drinker and overweight.

Complaining of acute central chest pain @ rest. Awoken by pain.

On Arrival - Sat upright on settee (Editor's note: One of you Brits will have to interpret that for me!)

On examination:

Alert, orientated and communicable (GCS 15)
Pale, cool dry skin.

Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 19, SpO2 99%

H/R 68 and irregular, BP 125/74

Temp 36.8
B.M 7.2 (Editor's note: B.M. is BGL measured in millimoles. 1 mmol/L of glucose is equivalent to 18 mg/dL. Hence, this patient's sugar is about 130).

C/O chest pain.

O - Acute. Awoken from sleep.
P - Nothing makes pain better. Not affected by breathing
Q - Non specific compressing type pain
R - Central chest pain radiating left arm
S - Pain score 6/10
T - 30 mins
I - No pain intervention sought.

Slight nausea, nil vomit

The cardiac monitor is attached.


A 12-lead ECG is captured.



Once again, I am impressed at the power of Web 2.0.!

Getting case studies like this from thousands of miles away is a real privilege and it makes me very happy to be able to share them with my colleagues from around the world!

This ECG meets all 3 of a certain criteria.

What criteria are we talking about and how would you treat this patient?

While you're at it, please CLICK HERE if you missed my previous post and cast your vote!

5 comments:

Adam Thompson, EMT-P said...

Tom,

Very nice case. I will let others take a chance at this before providing my interpretation. It is cases like this that make me want to push this criteria into prehospital education. Too many paramedics would take a look at this 12-lead and say "can't interpret".


ps. Who is Kelly Arashin?

Tom B said...

Kelly Arashin is a Clinical Nurse Specialist residing on Hilton Head Island and a finalist in the Chronicles of EMS "Change the Name" competition.

She is also my significant other! :)

Tom

Adam Thompson, EMT-P said...

Ahh, now I can put it all together. I saw her name in the finalist email. Well I guess I will have to wish you luck then. Hope you get the trip.

Anonymous said...

12 lead shows to be an inferiolateral acute infarct. You have elevation ii iii avf v5--v6. You also show depression in rec. Leads. She is presenting with classic signs for the male patient ie nocturnal dyspna chest pain with radiation down lefrt arm. With this she is showing involvment of both the rca and lad.

Anna Ashmore said...

Nice Reading. Thanks.
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