Case Studies 2018-12.pptx - RRMC EMS CASE REVIEW Dr Courtney Fuller MD Tyler Hock NRP CCP-C CASE 1 \u2022 EMS is called for a 66yo patient with chest pain

Case Studies 2018-12.pptx - RRMC EMS CASE REVIEW Dr...

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Dr. Courtney Fuller, MD Tyler Hock, NRP, CCP-C RRMC EMS CASE REVIEW
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CASE 1 EMS is called for a 66yo patient with chest pain. Sudden onset, substernal, numbness both arms. Has noted SOB, Diaphoresis, and Nausea. Hx: HTN, Pericarditis, Hypercholesterolemia. VS: BP: 161/127 P: 102 RR: 20 SPO2: 98 Pain: 7 Patient given Nitro, ASA, and Zofran by EMS.
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EMS ASSESSMENT Initial EKG
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CASE CONT. En-route patient complains of increased nausea and a change in the EKG is noted.
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Pt suddenly loses consciousness 9 min later
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AFTER 20 DEFIBS PATIENT ARRIVES IN ED
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ED TREATMENT AND COURSE EMS Treatment ASA, NTG, Zofran prior to arresting. Amiodarone 300mg Lidocaine 100mg ED Treatment Amiodarone 150mg Bicarb 50 mEq Metoprolol 5mg ASA and Heparin
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ED COURSE ED Assessment
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CASE CONT. ROSC achieved, post arrest EKG.
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ED COURSE Initial Labs
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CASE CONT. Patient transferred to PCI facility via ground. Door to balloon time was 4hrs 22mins missing the goal of 120 mins due to no air transport available (weather).
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CATH LAB REPORT LAD OCCLUSION
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CASE OUTCOME Patient discharged neurologically intact with good function.
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12 LEAD BREAK DOWN
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WHAT DO THOSE MEAN?
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WHO SHOULD BE GETTING A 12 LEAD? Remember ACS does not always present with classic symptoms. Patients presenting with Chest, jaw or arm discomfort SOB Epigastric pain Syncope, general malaise, palpitations, and unexplained nausea/vomiting If the patient has self admin NTG for symptoms they felt were related to ACS After sudden cardiac arrest with ROSC Be mindful of the elderly, females, and patients with a hx of diabetes. AND Please document the 12 lead in the procedure section in SIREN.
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STEMI CRITERA What is the definition of a STEMI? ST elevation in 2 contiguous leads of at least 1mm with reciprocal changes. (AHA 2018) Sgarbossa criteria can be used in LBBB and paced rhythms to determine MI.
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