63 Year Old Female, CC: Neck and Arm Pain–Discussion

  This is the discussion for our recent case 63 Year Old Female, CC: Neck and Arm Pain. Let's revisit the 12 Lead ECG: There "appears" to be a Sinus Brady rhythm at a rate of about 52 bpm, with a first degree AVB. The rhythm is regular for the first half of the ECG, then there appears to be a couple of PACs or PJCs in the second half. The axis is normal. There is ST elevation in leads II, III, and aVF and V6, with ST depression in I, aVL, V1 and V2.   As many of you correctly presumed, our patient was having an inferior STEMI, probably extending to the posterior and lateral walls. Was the RV involved? The crew did not perform right sided or posterior leads, so we do not have recorded ST elevation to confirm this. The ST elevation in III > II favors RV involvement, but there is no ST elevation in V1 (which would also favor RVI) , although the potential ST elevation in V1 may be hidden by the ST depression of the posterior involvement.  Since there was already STEMI, the crew did not run right sided or posterior leads, believing it would not alter their treatment. As the patient was normotensive,  the crew elected to give NTG in addition to ASA and withold fluids.  The PCI center was almost an hour away by ground, and the community hospital only 15 minutes way. The crew elected to transport the patient to the community hospital.  Do you agree with the treatment and transport decisions? The only follow...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics fire-rescue-topics patient-management Training training-development 12-Lead ECG bradycardia case study David Baumrind ems12lead.com first degree AVB inferior STEMI Paramedic Prehospital 12-Lead ECG blog second degree Source Type: research