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78 year old female chest pain

by on July 25, 2011

Called to the house of a 78 year old female patient. Family stated they called EMS because the patient was having chest pain with some shortness of breath. They stated she has been complaining since dinner at 1800 hrs. They originally thought she might be having indigestion but want her checked out to be sure. When asked about medical history they state High blood pressure, High cholesterol and diabetes. Medication of Crestor, Lopressor and Insulin (Humolog)

She is placed on 3 lead

A 12 lead is then captured with following info
HR 68
PR 160
QRS 137
QT 404
QTC 430

P 75
QRS 59
T 56

Family is stating if she needs to go to the hospital they wish for her to go to the one that is about 10 minutes from their house. That hospital is a non PCI center. There are PCI centers that are about 20 minutes from her house.

What is your interpretation and decision?

From → Case File

  1. 3L: SR w/ BBB and PACs.
    12L: SR w/ RBBB, PAC, inferior depression, inappropriate anteriolateral ST-concordance.

    Interpretation: anteriolateral STEMI.

    Explain the situation to the family, let them know the local hospital is inappropriate and if you take her there she’s just going to be transferred to the other hospital. If they insist on the local hospital, I’d call the local hospital and explain I have a STEMI and have them tell the family the pt is not welcome there and must be taken to the PCI center.

    Enroute to the PCI center I’d administer ASA, IV, NTG per BP and chest discomfort, repeat 12-leads, and notify with any changes.

  2. You da man, Christopher!

  3. Matt permalink

    From the looks of what I can see, it looks like a RBB with a PAC. But I can not zoom in to well to see if there are any elevation or depression. The other thing is to, there is a blood pressure but there is no blood pressure listing. I would treat the patient following our CHEST PAIN protocol and transport to the facility that is close. IV 02 NTG and asa.

  4. Anonymous permalink

    My partner says widow maker, I disagree. I agree there is something funky for a lack of a better term. Septal, and anterior possible Infarct. Go to the PCI. With MONA. BR

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