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51 YO Female chest pain

51 Yo female patient c/0 chest pain that radiates to her left arm.  She stated pain is 8/10 “feels like and elephant is sitting on me.”  She is short of breath and diaphoretic, lungs are clear and equal.  She states nothing makes her pain better or worse,  She has taken her daily ASA.  She is anxious and crying.   History of HTN, anxiety, CAD.  No allergies.   She stated she takes medication for her med hx but does not know the names of them.

12 lead obtained and V/S obtained

Respiration 22

BP 110/50

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STEMI

 

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Roadside to Bedside Conference

roadside to bedside

Waited too long?

Had a call during the night from a local ER transferring a patient to a Cath Lab for Posterior MI.  Pt stated he has had chest pain intermittent all day that became very strong and steady around 5PM.   It is now 11pm when the patient arrived at the  cath lab where a nurse met the crew in the hall way and stated the the Dr wanted to talk to the patient before he went to the Cath room.  The Dr seemed to be irritated. He told the patient that he has had a heart attack and waited too long to come for treatment and  it is now too late for him to do anything and was sending him back down to the ER for another 12 lead and Echo.

He was still showing ST depression in early V leads and still had chest pain 5/10 after 2″ NTG paste, 8mg MS and 100Mcg of Fentanyl.   Seems to me if he is still showing signs of posterior MI with an elevated Troponin level and having chest pain he should have at least done an exploratory cath if nothing else.  What are you thoughts?

Here is the EKG

posterior

45 yo, I Don’t feel so good!

45 yo male called 911 stating he does not feel good. EMS arrived on scene to find him sitting in his chair COA x 4. lungs are clear and he is short of breath. He stated he has taken a NTG without relief. Pain is 5/10 and he is slightly pale and diaphoretic.
BP 110/60
RR 20

12 lead obtained

stemi

Aside

55 Year Old Male Chest Pain Conclusion

Called EMS for chest pain and shortness of breath, which he states woke him up from sleep.  He stated he has been having chest pain for a few days but it usually goes away after he takes his Nitro.  He does have a cardiologist whom he states he has already called.

He appears pale and slightly diaphoretic

BP 100/65

RR 20

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Patient was a direct admission to the Cardiac Cath Lab with and Acute ST elevation inferior infarction.  Catheterization documented acute occlusion of the mid right coronary artery (RCA).  The RCA was opened with thrombectomy.

Door-to-Balloon (D2B): 26 Minutes / First Medical Contact to Balloon (E2B): 65 Minutes

55 year old male patient with chest pain

Called EMS for chest pain and shortness of breath, which he states woke him up from sleep.  He stated he has been having chest pain for a few days but it usually goes away after he takes his Nitro.  He does have a cardiologist whom he states he has already called. 

He appears pale and slightly diaphoretic

BP 100/65

RR 20

Image

57 year old male patient with Chest Pain

Patient presented to ED via local EMS with intermittent CP over past several days, acutely worse 30 minutes prior to arrival.  ED EKG showed ST-elevation in leads V1 through V3 with reciprocal depression in II, III, aVF, V5, and V6.  STEMI alert was called and patient taken emergently to the Cardiac Catheterization Laboratory.  Cath revealed 95% tubular stenosis in the proximal left anterior descending artery (LAD).  The LAD was treated with balloon angioplasty and stent.  Patient was discharged home

inferiorinferiorpic

Door-to-Balloon (D2B): 55 Minutes / First Medical Contact to Balloon (E2B):74 Minutes

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