Snapshot Case- No Day at the Beach

It is a beautiful summer afternoon when you and your partner are called to the beach for a “swimmer in distress”.
Upon your arrival, you find a 48 year old male sitting on a beach towel, appearing to be in some distress.
You are told that he was swimming in the ocean when he began to struggle, and was pulled out by bystanders.
Patient tells you that he developed a constant sharp pain in his chest, along with pain in his right arm, probably from overdoing the swimming he thinks. He says he feels a little better now.
He has no history, takes no meds, and tells you this has never happened before. He denies shortness of breath, lightheadedness, and nausea. Diaphoresis is hard to assess because the patient is still cool and wet from the water.

You get a set of vitals:

Pulse: 78 and regular
BP: 128/78
RR: 18 regular, lungs clear
SpO2: 96% on RA
Skin: cool and moist (out of the water)

You acquire a 12 lead ECG:

The community hospital is 12 minutes away by ground, and the STEMI center is 30 minutes away requiring Medevac transport.
For context, your system has had an issue with false positive cath lab activations, making activations from the field a little more difficult subject to system review.

Back to this call:

What is your ECG interpretation?
How will you treat your patient?
Will you take your patient to the closest hospital, or activate the cath lab?

Source: EMS 12-Lead - October 15, 2016 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg Cases ems-health-safety patient-management training-development 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog Source Type: research