Chest Pain / STEMI Candidate

The patient is a 66 year old white male presenting with substernal chest pain he rates an “8” on a 1-10 scale. He reports an acute onset at appx. 11:00 hrs this date while at rest.

The pain is described as a heaviness or “crushing” chest pain and is similar to pain the patient experienced during a prior heart attack. The patient states that the pain does not radiate, nor does anything make the pain better or worse. The patient denies SOB.

The patient has an extensive cardiac history with four prior stents.

Upon EMS arrival, patient is conscious, alert, and ambulatory. The pulse is 78 and bounding. Respirations are 18 and non-labored. The blood pressure is 160/78. The skin is pale, warm, and dry. Pupils are dilated and sluggish. Breath sounds are clear, present, and equal. Heart sounds are abnormal with a pronounced S4 Gallup. The pulse oximeter reads 98% on room air. The EKG shows a sinus rhythm with left atrial enlargement, a possible anteroseptal infarct, and ST changes suggesting and inferior wall MI.

Automated ECG interpretation software reports suspicion of an acute MI.

smaller_acute_mi

Treatment:

The patient was placed on the stretcher and moved to the ambulance. Med Comm was contacted and asked to relay the possible acute MI to <BLANK> Medical Center. An IV was established in the Left AC running Normal Saline TKO. Blood was drawn as per the ALS protocol. The patient was given 0.4 mg sublingual nitroglycerine at 1230 with a second dose of 0.4 mg given at 1236. The patient reports already having taken 4 x 81 mg Aspirin prior to EMS arrival. The patient was transported to <BLANK> aboard <BLANK> using lights and siren, arriving at the hospital within 20 minutes of leaving the scene. Upon arrival at <BLANK>, the ambulance was met at the ER door by Dr. <BLANK> and other members of the hospital staff. Verbal reports were relayed immediately while walking directly from the ER door to the Cardiac Catheterization Laboratory. The patient was directly transferred from the ambulance stretcher to the procedure table within the cath lab and the patient’s blood samples were relayed to laboratory staff at that time. Transport was without incident.