Here’s another great case submitted by Nick Ciaravella of Grady EMS in Atlanta, GA.
66 year old male presents to EMS with chest pain.
S – Chest Pain
A – None
M – Atenolol, HCTZ
P – HTN
L – meal, 7 hours prior to event
E – Mowing his lawn
O – Started while mowing his lawn
P – Provoked while exerting himself, Palliated initially when he sat down to rest
Q – Sharp
R – Substernal, initially radiating to his jaw, when he rested the pain was only in his chest
S – Initially 10/10, upon ems arrival 4/10, en route 8/10, 9/10, and 10/10 upon arrival at ED
T – No previous episodes
The patient initially presented to EMS with 4/10 pain and vitals as follows, 148/84, pulse 72, 18 respirations, SPO2 96%, Lung sounds clear and equal, BGL 103.
The patient was placed on 3 LPM O2 via NC, given 324 mg Aspirin PO, given 0.4 mg Nitro Tablet Sublingual and then 1 inch of Nitro Paste Transdermal. The Patients pain increased en route to the ED and began to radiate down his left arm en route.
12-lead ECG #1
12-lead ECG #2 (about 15 minutes later)
What do you think?
Pure (Isolated) Posterior STEMI — not so rare, but often ignored! – Dr. Smith’s ECG Blog