ECG Challenge: The court’s verdict?

How would you treat this patient and why?

March 14, 2013 07:43 AM •

Editor’s note: Check out this month’s ECG case study and submit your treatment plan in the comments below. If Tom selects your plan as the best, you could win an EMS1 T-shirt and bottle opener. Good luck!

EMS is called to a local tennis court for a 63-year-old male complaining of chest pain.

At the time of EMS arrival, the patient is found sitting on a bench.

Past medical history: Cataract, erectile dysfunction

Medications: Cialis (tadalifil)

The patient appears acutely ill. He is pale, warm, and diaphoretic.

Vital signs are assessed.

RR: 18
HR: 74
NIBP: 127/65
SpO2: 97 on RA

Breath sounds: clear bilaterally

The patient is placed on oxygen via NC mask @ 4 LPM as the cardiac monitor is attached.

A 12-lead ECG is obtained.

What do you think of the 12-lead ECG?

Is the local community hospital appropriate or should the patient be transported straight to a PCI-capable facility?

How would you treat this patient?

Cardiac Care

Tom Bouthillet, NREMT-P

Tom Bouthillet, NREMT-P, is the battalion chief of EMS for Hilton Head Island Fire Rescue. He is a member of NHTSA’s High Performance CPR Working Group, program director of the South Carolina Resuscitation Academy, member of the Editorial Advisory Board of EMS World, content reviewer for the British Paramedic Journal, co-producer of the Code STEMI web series, and editor of EMS12Lead.com. Tom is interested in system performance, process improvement, and evidence-based performance measures for time-sensitive diagnoses.

He graduated with a paramedic/paramedicine degree from Parma Community Hospital EMS Education Program. His writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest.