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54 year old male chest pain

by on September 24, 2011

Male, 54 Years old
Hx: HTN, CHF, CAD, No Hx of MI
CC: Chest pain radiating to Right arm.
HPI: PT reports onset of CP approximately 10 minutes prior to EMS arrival. States pain is “severe” pressure type pain, 5/10, and located slightly left of sternum and radiating into right arm. Reports some Shortness of breath, denies N/V. Reports several day history of mild chest pain upon exertion that is relieved by rest, but the pain today is “worse that anything he’s ever felt.” States he takes an ASA daily, but has not taken anything for the pain since it started.
PE: Average size male, slightly overwieght approx 220 lbs, sitting upright in chair, CAOx4. Patent airway, BBS clear/equal. Skin pale cool/clammy. PT is very anxious and diaphoretic, slightly rapid breathing. Radial pulse present, regular. ABD soft, non-tender. PERRL. No JVD noted. Slight pedal edema present.
Rx: 02 via NRB, 12-lead stat showing Antero-lateral STEMI. 324 ASA, .04 NTG q5 to total of 3 doses. IV, BGL. After 2nd NTG, follow up 12 lead obtained showing strong reduction of ST elevation in anteriolateral leads. PT expresses some relief and pain down to 2/10.
Outcome: Cath lab activated by ER Doctor upon receipt of 1st 12-lead. Upon arrival to ED, Doctor states that if the second 12-lead would have come first, cath lab would not have been activated. PT was started on NTG drip and taken to the cath lab within 15 or so minutes of our arrival to ED.

first 12 lead

second 12 lead after prehospital treatment

Another reason to obtain early 12 lead before treatment.

From → Case File, Education

  1. VinceD permalink

    Very nice case with a good lesson, thanks for sharing

  2. Excellent, practical example of how things should be done! Thanks

  3. neat. dr. smith has also has an interesting post on the importance of doing a baseline 12-lead – totally affects cath lab decision in cases like this.

  4. Anonymous permalink

    good case thanks for sharing!

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