EMS received a call for a 95 yo female who began having chest pain x 2 hours with nausea. Pt has a hx of dementia. Pain is 10/10. EMS obtained a 12 lead ekg. LBBB with positive Sgarbossa criteria for concordant ST elevation in the inferior and lower lateral leads with concordant ST depression in V1-V2.
EMS calls for air medical transport since the nearest PCI center is an hour away. Prior to air medical transport arrival pt has been given 4mg MS, 325mg ASA, and 4mg Zofran
IV is patent running kvo rate BP is now 83/47 Respirations 20 and pulse is 54.
Air medical crew initiates another IV and runs fluid w/o to bring BP up to 107/55. Pt is dropped off at the Cath Lab.
59 yo male pt called ems, he states that he has had abdominal pain for 2 day and today started having chest pain that is getting worse. 8/10 pain. BP 102/70 skin is warm and dry. During transport pt has 2 syncopal episodes. Crew drops off patient at ER. Pt receives 325mg ASA and NTG SL x3 and a total of 10mg MS for pain. He is also given 2000ml Normal Saline. Air medical transport is called for transport to a PCI center for intervention.
EMS calls for air medical transport. EMS give report to air crew stating that they have a 55 yo male patient that is not feeling well. They state that the pt has a hx of HTN and some coronary issues in the past. Pain is 8/10 with shortness of breath and some nausea. They have him on 15lpm NRB and have ran a 12 lead and they report inferior MI. They have started one IV in the hand running at KVO rate. They report BP is 150/80.
No NTG given per the crew due to the Inferior MI. They wish for the Air Crew to continue treatment and transport.
EKG
What do you Think about this call? Do you think the EMS crew should have given the patient NTG?
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
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
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
