59 year old male: chest pressure – Conclusion

This is the conclusion to 59 year old male: chest pressure, be sure to read the case study first! When we left off, we’d loaded our 59 year old male patient with 10 of 10 chest pressure into the back of our unit with the help of a local volunteer EMT. The patient appeared acutely unwell and was hypotensive and bradycardic. We had the following initial ECG: Before we discuss this ECG in depth, let’s show a serial 12-Lead the crew obtained shortly after leaving the scene: The importance of serial ECG’s cannot be understated. Using only one prehospital ECG could miss nearly 20% of all STEMI patients! At this point we can see an obvious inferoposterior STEMI, likely due to an RCA occlusion. Also of note is a new right bundle branch block, which is an ominous sign. These changes were not lost on the crew, and the receiving facility, a PCI center, was made aware. However, during their radio report a rhythm change was noted on the monitor: A single R-on-T PVC is seen initiating ventricular fibrillation. Thankfully, the crew elected to use a driver and had two sets of hands in the back. The defibrillator was charged while CPR was initiated, and a 200J shock was delivered after a period of chest compressions: A rhythm change was noted, however, as no pulses were present chest compressions were continued: Within a minute the patient awoke during CPR, and regained full consciousness. A repeat 12-Lead was obtained: This ECG shows sinus tachycardia, right bundle b...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics patient-management 12-Lead ECG acute inferior STEMI cardiac arrest case study Christopher Watford EMS 12-Lead hyperacute T-waves Paramedic RBBB right bundle branch block sudden cardiac arrest Source Type: research