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“I only had two beers!”

by on June 15, 2011

Hello everyone,  This is your friendly, neighborhood guest contributor coming to you live while the blog author is off getting married! (Congrats!)

Here is a new case study based on a recent call ran by an EMS crew.  This is a pretty interesting case and involved a great presentation.

PT is a 53 year old male that calls 911 for chest pain.  The patient reports that he came home from work and wanted to relax and cracked open a beer.  He states he had “only two beers” when he suddenly began to experienced a sub-sternal “squeezing” pain in his chest that he thought was indigestion.  Pain is non-radiating 10/10. He states the sensation was so bad it made him become nauseous and vomit.  He denies any history of Heart disease or any medical problems and states he doesn’t take any medicines or have any allergies, but states his father has a MI at age 55. Upon EMS crew arrival, the patient was very anxious and also complaining of shortness of breath. Physical Exam reveals the following:

CAOx4 with BS clear/equal, and skin pale,  cool/clammy. HEENT clear. Bounding radial pulse present. No JVD or pedal edema is noted.  ABD area is non-tender.

V/S as follows:

BP: 196/116,
Pulse: 88 regular,
RR: 22, non-labored,
Sp02: 99% on room air.

A 12 lead EKG is obtained:

A follow up 12-lead EKG is obtained with the addition of V4R:

Distance from hospital with PCI: 15 miles.

What is your field diagnosis, and more importantly, how would you treat this patient?

From → Case File

  1. Chris Tanerillo permalink

    Inferior STEMI with riciprocal changes and RV involvment. High RCA occl. ASA if no contraindication,IVx2, Zofran 4mg IV, call local medical control to bypass local ED for cath lab. Start NS bolus, Start low dose nitro drip 10mcg/min carefully reassess. Carefully adjust nitro drip to pain or BP this way if pressure becomes a problem I can back off on the nitro or stop it, no messing with SL nitro on this one if I have drip, 25-50mcg fentanyl if pt needs additional pain relief with consideration to preserving preload. Repeat 12 lead, carefully reasess. Early hospital notification, consider helicopter intercept if it would be faster.

  2. yuck.

    “i guess you outdid your father, sir.”

    and congratulations to blog author.

  3. Simon permalink

    LV aneurysm morphology persistent ST elevation with a q in III with reciprocal changes

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