Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.

Recap In the post yesterday , the paramedic crew was evaluating a 38 y.o. male who had sudden, severe chest pain, as well as leg numbness and paralysis, and whose vital signs showed a mild bradycardia and pronounced hypertension. The ECG obtained by EMS appears to be junctional, with an unclear contribution from the SA node. More concerning, however, is the ST segment elevation in V2-V5, with modest ST depression in aVF and perhaps in III. This would usually define an anterior wall acute coronary occlusion (i.e. STEMI). However, the depth of the S wave in V2 and V3, combined with the high R wave in V5 and V6, strongly suggest that left ventricular hypertrophy (LVH) is complicating interpretation of the ECG. Clinical Course At the time, the ED did not activate the cardiac catheterization lab based on paramedic interpretation of a STEMI. However, the emergency physician met the EMS crew as they were backing in, and immediately called for cath lab activation from the parking lot. Given the “off-hours” presentation, the patient was evaluated in the ED while the cath lab team was assembling. The patient received multiple doses of morphine for the unremitting pain, and in fact was administered over 60 mg of morphine over the next hour, with no hypoxia or lethargy. The ED physician asked for a repeat ECG, assuming that it would demonstrate evolution of an ongoing and large MI. This ECG was obtained about 20 minutes after the EMS ECG: Although there were minor changes i...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research