68 Year Old Male: Chest Tightness – Part 2

This is part 2 of a multi-part series examining a 68-year-old male patient who presented with a chief complaint of "chest tightness" and an abnormal ECG. You may want to review the initial description of the patient here. We're going to save the dissection of the ECG's for the next post and continue on with his case presentation for now… You start by administering 324mg of aspirin PO, chewed well. Recognizing that the patient is in rapid atrial fibrillation at about 127 bpm and that his elevated heart-rate could be contributing to his symptoms, you start to draw up a loading-dose of diltiazem to slowly bring his rate under control. However, before you can administer the medication, you notice a change on the monitor and shoot a 12-lead.   For good measure you shoot an ECG with posterior leads V7-V9 as well (Note: Whenever I print a posterior ECG I do so at 2x gain).   Aside from an obvious decrease in the patient's heart rate, his vitals are unchanged. You question him closely about his symptoms and they are still exactly the same. He is still experiencing chest discomfort that he rates as a 6 out of 10, absolutely no different from when he first presented. "Well maybe it wasn't the a-fib giving him symptoms…" you think. You administer 0.4mg of nitro SL, reassess his pain as being mildly reduced to a 5/10, and run another 12-lead.   You administer a second dose of 0.4mg nitro SL, reassess his pain as being 3/1...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG case study EMS 12-Lead ems12lead.com posterior leads ST-depression ST-elevation in lead aVR Vince DiGiulio Source Type: research