45 yo WF relates h/o nausea & CP x several hours. ØPMH, Ømed | Figure 1

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Patient Case Summary

45 yo WF relates h/o nausea & CP x several hours. ØPMH, Ømeds, father has extensive cardiac hx. Pt's father takes her POV to ER. ~5 mins from hosp, pt states she feels like she's going to pass out, and arrests shortly thereafter (1130). Pt's father continued POV. ROSC achieved in ER, EKG obtained as pictured. Ground transport to PCI-capable facility arranged (no 🚡 available), pt transported on propofol, DA, amio, lido, & heparin gtts w/o incident; VS en route 100/60, 130s, BGL 330. Cath lab @ 1340; what do you think they found? Do you agree with decision to transfer for PCI given timeline?

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Prehospital 31 yom, obese. No admission of PMHx. Prodromal chest pain, asymptomatic on EMS arrival, refusing transport. Convince pt to be evaluated. Pt seen in ER one week prior for similar sxs. 12 lead 1 taken on scene. Repeat 12 lead 2 and 3 taken enroute on return of CP. ASA and NTG given, cardiac alert called. 12 lead repeated several more times. Pt taken to cath lab, 99% occluded LMCA. I assume some coronary spasm was present as well.

I learned something new on this call. 45 y/o male, GCS 15, c/o chest "pressure." Vomited 1x prior to calling 911. Pale and diaphoretic. Pt appears very scared and anxious. My partner called one of our local PCI capable hospitals and activated the cath lab based only on this 1st ECG. What did he see on the 1st ECG that made him certain this was a STEMI?

STEMI first thing this am. Father passed last evening, patient developed chest pain shortly after. Came to ER POV at 0630.

EMS was dispatched to a chest pain for a 60 Y/O F. While enroute dispatch advised that she was nauseous and was having difficulty breathing. Upon arrival EMS made contact with the patient at the front door. She immediately went to the bathroom and vomited once. After she vomited she stood up, turned towards the showers and collapsed. The Pt was moved to the living room where it was determined that she was pluseless and apenic. CPR was started and the pads were applied with the first shock being delivered within 60 seconds of collapse. No rhythm change was noted with the first shock and CPR was continued. After the second shock was delivered a rhythm change was noted in the third picture. A carotid pulse was confirmed and a 12 lead was obtained. At that time the Pt regained consciousness and was A&OX4. IV access was obtained and the cath lab was activated on scene. During transport the Pt maintained stable vitals and was talking with EMS the entire time. The Pt was transferred over to the ER and then to the cath lab where it was determined that she had a 100% occluded proximal LAD. Four days later the Pt was discharged home and I was able to meet her again a month later at a case presentation at the hospital. It's always nice to see the outcome of our most critical patients and the importance of a strong EMS system. If y'all have any questions fire away.