# Chest pain with head trauma



## SunshineCamo (Aug 10, 2016)

This was a scenario put to me recently. 66 year old man complaining of chest pain after a syncopal episode and hitting his head. Vitals are within normal limits, BP slightly elevated. 12-lead shows ST elevation in lateral leads. 3" laceration to the back of his head. States "I felt light-headed and my chest started hurting. I fell and hit my head".

Because of the head trauma I didn't go the chest pain protocol route. Looking back now I think I should have at very least asked medical control, and probably should have treated the chest pain.


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## cprted (Aug 10, 2016)

Why do you think he fell?


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## NomadicMedic (Aug 10, 2016)

There are only three things that'll put you on the ground. Your head, your heart and your sugar.


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## RedAirplane (Aug 11, 2016)

How's his mental status doing 5, 10, 15 minutes after initial contact?


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## SpecialK (Aug 11, 2016)

Chest pain, history of syncope and ST elevation in the lateral leads? STEMI until proven otherwise.

He has an iimmediate threat to his life and needs to immediately go to a catheter lab.

The head laceration is largely irrelevant, his primary problem is STEMI.


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## ERDoc (Aug 11, 2016)

I think what the OP is asking if the pt should have been given ASA for the STEMI in the setting of a head injury.  The answer is that is depends on the height of the fall.  If it was a fall from standing then no problem.  If he fell 10 feet off a ladder, then I would hold.


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## SunshineCamo (Aug 11, 2016)

ERDoc said:


> I think what the OP is asking if the pt should have been given ASA for the STEMI in the setting of a head injury.  The answer is that is depends on the height of the fall.  If it was a fall from standing then no problem.  If he fell 10 feet off a ladder, then I would hold.



This was my main question. I had a feeling a made the wrong decision and it definitely seems that I did.


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## ERDoc (Aug 11, 2016)

It all depends on how your protocols are written.  Was the pt on any sort of anti-coagulation?  No one is going to fault you for not giving aspirin, especially if you document the reason.


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