But she has never felt a pressure like this before and she says it feels like someone sitting on her chest. Her skin is warm and dry. BP 150/90. P- 108. Sat 100% on room air.
No prior history, though given her race and weight, she looks like she might have hypertension and high cholestrol.
Out in the ambulance, I put her on the monitor. Doesn't look too bad at first glance. Of course I am just looking at the inferior leads.
This could just be stress I tell her, but we are going to treat you like its your heart. We're required too.
I do a 12 lead.
Looks a little suspicious. V-6 is troubling. V-5 just a touch. The inferior leads look ever so slightly up. Maybe it is just a variant for her.
I give ASA and NTG, which brings no relief. Her pressure holds steady. I call the hospital, and let them know I have a chest pain with a borderline ECG, possible ST elevation in lateral leads.
I do another 12-Lead. The patient asks how it is. She sees something in my face as I stare at it.
Holy. Looks nasty. Particuarly in V-4 -V6. Such a change in ten minutes. In addition to the lateral there is fresh change inferiorly with an ominous cove shaping of the ST.
At the hospital I tell the triage nurse I believe my patient is having an MI. She says they are getting a room ready for us. I ask who the doctor is. She tells me it is a new physician and points in her direction. Sitting next to her I see one of hospital's best physicians, who is very EMS oriented. After I give a report to the nurse and get the patient on the bed, I go over to the doctor I know and show him the strips. He asks what room and I tell him. He immediately shows the strips to the new physician. He tells her the process for calling the cath lab.
I write my report and as I am bringing it back to the room, they are already wheeling the patient out, headed to the cath lab.
Nice turn around.
