Secrets Behind the Curtain

“Doc to the radio phone,” went the call over the PA. This is often just medics notifying about a diabetic refusing transport or stopping a futile code, though like most of emergency medicine, it can be anything. Then we heard, “STEMI. Activating prehospital.” EMS had been called to the house of a 54-year-old man. He had been experiencing chest pain on and off for several weeks. The most recent episode began about 30 minutes prior to ED arrival. He described 8/10 retrosternal pressure that radiated down his arms. He was tachypneic, but denied shortness of breath and was not hypoxic. Other vital signs were normal. He was slightly nauseated, but had not vomited and was not diaphoretic. Paramedics treated the patient with sublingual nitroglycerin and aspirin, and obtained an ECG en route to the hospital. (Figure 1.) Figure 1. Presenting 12-lead ECG. The ECG showed sinus rhythm with a rate about 60 bpm. There is diffuse ST-segment elevation in V2-V5, II, III, and aVF, with reciprocal depression in aVL. Maximal ST-elevation is 3-4 mm in lead V3. As part of the effort to reduce door-to-balloon time, our paramedics can activate the cardiac catheterization lab based on the clinical history and a 12-lead ECG obtained in the field that indicates STEMI, which is what they had done. Once in the ED, the patient was given an additional sublingual nitroglycerin for ongoing chest pain and clopidogrel 600 mg. While the cardiac catheterization lab was being prepared, an emergent...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs