Check out this poor patient (ECG)

[fiznat]

60 y/o female complaining of an acute onset of general weakness, throat pain ("like razor blades in my throat") and toothache while doing housecleaning. No past medical history or meds.

Edited August 30, 2009 by fiznat

[tniuqs]

Cardinal Tombstone "T"s

[CBEMT]

Oww. I'm getting chest pain just looking at it.

How were the vitals?

Edited August 31, 2009 by CBEMT

[tniuqs]

V/S would be nice and meds too and what she actually looked like ... anyone notice the plastic brain saying NSR ... that is kinda a stretch for P wave interval in my books for first degree block, then again who am i to disagree with the programmer ...lol.

Anyone notice the escape beat in the first record ? Would you hang your hat on that as a PJC, PAC or PVC ?

An interesting suggestion/concept was discussed by a prominent MD and myself concerning the relashionship to a certain type of bacteria found in the mouth, presently being studied and an atypical increased occurrence with MI but a trend nevertheless .

His opinion was that many of the demographic group that present with M.I. also have other factors as poor diet and exercise routines in addition to high cholesterol, his suggestion was that poor dental hygiene also a factor due socioeconomically status, in many cases dispelling the suggestion of a oral bacterial infection being directly linked to M.I.

Point being this woman could have an abscessed tooth as well as the initial complaint, but seriously just posting a complaint and an 12 lead ... what direction are we supposed to go with this thread ?

cheers

Edited August 31, 2009 by tniuqs

[ERDoc]

You know, there seems to be a saying around here (and EMS in general), "Treat the pt, not the monitor." I cannot stand this statement. The monitor is part of your assesment. It is no different than if you found an obviously deformed forearm on a pt who fell. There are just some 12 leads that you cannot ignore, despite how your pt looks or is feeling. This would be one of those. This is a STEMI, unless your cath tells you otherwise. Does it really matter what her symptoms are? You will be very hard pressed to find someone that would say, "Eh, since she has no chest pain and her vitals are stable, that is probably her base line."

Maybe we should have a section for interesting EKGs/rhythm strips.

Edited September 1, 2009 by ERDoc

[FireMedic65]

I always hated that statement as well. A lot of your treatment comes from the equipment. You generally can't just look at your patient and start treating them without using the monitor and other equipment. Although vitals do make a difference in what you do, they aren't everything, especially in this situation. I would have crapped a cinder block.

The ECG section is a fantastic idea. Post an interesting strip, explain it, patient condition... I'm all for that! I'd lurk around that section quite a bit. Great thinking DOC!

[mobey]

"Eh, since she has no chest pain and her vitals are stable, that is probably her base line."

OH YA.... You assume that is what us Canadians are thinking Eh??

Jeez, yet another pregidous Doc

/sarcasm

[EMT Foose]

Good call on the right side ekg.

Looks like RVI to me. Good thing she's not in pain, because NTG and morphine wouldn't be good things to give her.

[fiznat]

Good call on the right side ekg.

Looks like RVI to me. Good thing she's not in pain, because NTG and morphine wouldn't be good things to give her.

Actually we gave NTG three times. The pressure, surprisingly enough, started in the 160/80 range and dipped only slightly after the NTG treatments. Knowing there was right side involvement was definitely important, though. We held off on the NTG until we had IVs in place.

That "treat your patient not the monitor" discussion is interesting, though. I really didn't think much about this patient until I laid eyes on her EKG. She was warm/pink/dry, looking overall pretty decent and only with some minor complaints that didn't seem to be bothering her all that much. I mean, come on. Toothache? The monitor told a different story...

Edited September 3, 2009 by fiznat

[DwayneEMTP]

I've always thought of that term in the inverse..

An MI presentation is still a possible MI despite the monitor telling you that all is well.

Unfortunately as long as we still have chuckleheads that believe that their pulse Ox can give you life/treatment altering information despite pt presentation then we'll continue to need such reminders.

Thanks for sharing all.

Dwayne

Edited for typos only.

Edited September 3, 2009 by DwayneEMTP