EKG Case Study #15: Mowing the Lawn Leads to Chest Pain

HPI

You and your partner are called emergently to a private residence for a 50yom experiencing chest discomfort and shortness of breath. The patient is seated on his front steps, stating that the pain started shortly after mowing his lawn approximately 45 minutes ago. The pain is dull and mid-sternal; the patient also has gerd, and states that he went inside and took “an Alka-seltzer” with no relief. His skin is flush, moist, and warm.

HISTORY

  • Gerd
  • HTN
  • Smoker

MEDICATIONS

  • Lisinopril
  • Pantoprazole
  • Nicotine patches

ALLERGIES

  • NKDA

12-LEAD

STEMI

VITAL SIGNS

  • BP: 168/104
  • RR: 28bpm
    • Unlabored but tachypneic
    • Lung sounds are clear and equal bilaterally
    • Patient able to speak in complete sentences between breath
    • Equal rise and fall
  • HR: 76/equal with a bounding pulse
  • SpO2: 96% on R/A
  • BGL: 139mg/dl

TREATMENT

  • 324.0mg ASA
  • O2 @ 2lpm via cannula
  • Large bore IV start with lab draw
  • 0.4mg SL Nitro with no pain improvement
  • 100.0mcg Fentanyl IV with no pain improvement
  • 4.0mg Zofran IV with improved nausea

FOLLOW UP

  • Crew called a STEMI activate from the field
  • Emergent transport to PCI Center
    • No change in vital signs or mentation en route
  • 100% LAD occlusion
    • PCI performed with full recovery

TALK POINTS