Dr. Courtney Fuller, MD Tyler Hock, NRP, CCP-C RRMC EMS CASE REVIEW
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.
EMS ASSESSMENT • Initial EKG
CASE CONT. • En-route patient complains of increased nausea and a change in the EKG is noted.
• Pt suddenly loses consciousness 9 min later
AFTER 20 DEFIBS PATIENT ARRIVES IN ED
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
ED COURSE • ED Assessment
CASE CONT. • ROSC achieved, post arrest EKG.
ED COURSE • Initial Labs
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).
CATH LAB REPORT LAD OCCLUSION
CASE OUTCOME • Patient discharged neurologically intact with good function.
12 LEAD BREAK DOWN
WHAT DO THOSE MEAN?
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.
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.
- Fall '19