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87 year old female not feeling well

by on November 25, 2011

EMS called to home of an 87 year old female patient who found sitting in a chair. Skin pale but dry complaining of weakness and chest discomfort with shortness of breath. She stated that she has not been feeling well for the last hour or so and had her family call 911. History of high blood pressure on Lopressor. She states that she gets really lightheaded when she attempts to stand up. Her chest discomfort is a 4/10 and feels like pressure but does not radiate. She has never experienced any type of symptoms like this before. As EMS crew is about to load patient onto the stretcher the patient states she feels as if she is going to pass out then becomes unresponsive.

Radial pulses not present but she does have a carotid pulse that is slow and very weak on palpation.

From → Case File, Education

  1. Yeah, I’d say she’s got herself a 100% proximal RCA. Pacing or fluids and epi drip or dopamine.

  2. BR- Paramedic permalink

    Inferior, anterior, and lateral involvement as far as a STEMI goes. I would be calling Med control and not to concerned about ASA and NTG due to possible low B/P and low on the pain scale, and also have the pads on ready to pace. When our new S.O’s come out due to her being unstable, no orders needed go straight to pacing, if possible some type of sedation. Bolus would probably be good if BBS are clear. I believe atropine could be attempted in this case, but I would not waste much time on it due to the fact it probably won’t touch her 3rd degree block. 1st and foremost maintain a good o2 level.

  3. Anonymous permalink

    This is a Great case,….. This women needs IMMEDIATE care….. I am glad you pointed out the Obvious 3rd degree that she has…. because after one idenfies that then it is very easy for me to skip the Atropine and go to Pacing…. Had this Exact same case 1 month ago

  4. Impressive third degree block. What’s really surprising to me is the degree of the ST-elevation and secondary changes. I’ve been told that females and elderly patients are less likely to exhibit a very prominent STEMI pattern (but have never verified it), let alone an elderly woman. In fact, my gut reaction was that it must be a monitoring lead with distortion from the filter until my eyes drifted right and saw the remaining 9 leads. Thanks for posting.

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