Pediatric Cardiac...with obvious ST changes

[FL_Medic]

Eh, Basic question... Does the pain radiate anywhere? What does V4R show? Posterior V7,V8,V9 show any depression, Elevation? LBBB new for this PT?, ACS maybe, With Timeline, Transmural Infarct maybe, Myocarditis... Maybe. Cardiac packet labs. CPk-MB^, Troponin^, BUN/Creatine^, Potassium^, WBC^? Syncopal episodes? Febrile? Pupils equal/reactive? H/A? Tinnitus? Blurred vision? Paresthesia? Any HX of AMS in recent hours?

I disagree with FL_Medic on Paramedics interpreting 12 Leads. If you, Or your Medics have issues with 12 Leads in your area, Then maybe y'all should reevaluate your curriculum. Why would you even consider not doing a 12 Lead with a 3,4,5 lead showing ectopy? ECG Interpretation in the field is huge in our area with our Medical Directors and receiving facilities. And yes... I said diagnose and treat for the people about to jump all over that. Maybe we just have good training, And know what were doing? Don't mean to sound arrogant.

I meant for pediatric patients. If you read my blog you will see I a more than an advocate for 12-leads which are the standard of care. Pediatric patients exhibit 12-lead findings that even ER physicians don't understand.

[NRPinNEPA]

4lpm via nasal cannula.

IV access.

Repeat 12-lead.

15-lead and right-sided 12-lead to capture V4R, V5R, V6R, V7, V8, and V9.

Labs: Cardiac enzymes, CBC, electrolytes, BUN and creatinine for giggles.

Contact the doctor and request a transport capable advanced life support unit.

Since the ST elevation is basically global and the chest pain is reproducible, I'm leaning away from ACS.

[speedygodzilla]

Besides the pericarditis I would suspect electrolyte imbalance, or drug abuse. Get the child alone and and ask him question pertinent to drug abuse.

-->Any recent drug or alcohol use?

At the age 11 it is not my first or highest index of suspicion but it did come to mind.

Ask dad the same questions too.

Another food for thought is has the pt been vomiting recently thus increasing my suspicion of electrolyte imbalance.

To the test above add CMP, and drug screen as available.

Nothing really to add to the treatment other than an emphasis on calling transporting and getting this patient to the ER.

From the looks of what you have provide it appears the physical exam is normal. Does a head to toe exam provide anything besides the "usual?"

[maverick56]

You mentioned that he is on Adderall. I would ask him (maybe away from dad) if he has taken more than his usual dose recently? If so, how much and for how long? Although this would generally cause his HR and BP to go up, there's always the exception to the rule. Meanwhile, Adderall frequently causes conduction problems and chest pain in rare occurrences. I would also check drug levels in labs. Also, has he tried anyone else's meds, maybe at school? Mixing of ADHD drugs can be bad news.