# Shoulder pain



## Chris EMT J (May 5, 2022)

69 y/o male CC of shoulder pain 
BLS transmitted a ECG to our ALS unit and the paramedic said there was ST elevation in anterior leads. So we ask there eta and it was 20min at the point we are on there way to the hospital so they are en route and meet us and we take the patient. So there were 2 EMT Bs one took there ambulance and the other drove ours so me and the medic could be in the back. I gave some aspirin and cycled the BP.  Medic started a line flushed it once and we arrived within 8min so not much we could have done in the time frame but establish a line. Question how often do you see a myocardial infarction that presents only with shoulder or nausea or jaw or back pain?


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## mgr22 (May 5, 2022)

ChrisEMTA said:


> Question how often do you see a myocardial infarction that presents only with shoulder or nausea or jaw or back pain?


Could be any of the above, alone or combined, anytime. In general, women and the elderly are more likely to present with symptoms other than classic ischemic chest pain. It's unwise to rule out an MI based on symptoms alone.


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## Chris EMT J (May 5, 2022)

mgr22 said:


> Could be any of the above, alone or combined, anytime. In general, women and the elderly are more likely to present with symptoms other than classic ischemic chest pain. It's unwise to rule out an MI based on symptoms alone.


Yeah I just don't see it often but it was a great thing the EMT basic did a ECG.


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## Akulahawk (May 6, 2022)

ChrisEMTA said:


> Question how often do you see a myocardial infarction that presents only with shoulder or nausea or jaw or back pain?


Often enough... Any of those symptoms without some discernable cause would put MI high up on the list of possible problems. However the "pain" isn't the usual "ouch I did something to myself" and it's not the typical "dental/toothache" pain, so that's a reason to ask the patient to describe the pain to you. A plain "it hurts" isn't enough.


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## DrParasite (May 6, 2022)

ChrisEMTA said:


> 69 y/o male CC of shoulder pain
> BLS transmitted a ECG to our ALS unit and the paramedic said there was ST elevation in anterior leads. So we ask there eta and it was 20min at the point we are on there way to the hospital so they are en route and meet us and we take the patient.


Cool on the BLS to take a 12 lead... idk if I would have for isolated shoulder pain, with no other symptoms, but they did and the paramedic saw something. so kudos to them.


ChrisEMTA said:


> So there were 2 EMT Bs one took there ambulance and the other drove ours so me and the medic could be in the back. I gave some aspirin and cycled the BP.  Medic started a line flushed it once and we arrived within 8min so not much we could have done in the time frame but establish a line. Question how often do you see a myocardial infarction that presents only with shoulder or nausea or jaw or back pain?


Those isolated single complaints are rarely an MI... however, when you add it the patient's age, any history, events leading up the the onset, vitals, and the description of the pain, as well as your complete physical exam, and the possibility of an MI increases.

Here is another question for you to ponder... did you (a paramedic ambulance) being there really help the patient?  BLS can give aspirin (in theory, its in the BLS scope for most areas), and they can do vitals.  Your paramedic has already identified the ST elevation without even being there; the only thing that I can see this affecting is the hospital destination.  if the BLS crew is going to an ER with a CATH lab (in case the ST elevation needs a CATH lab to fix), and can request a CODE MI response (or whatever your local ER protocol is for a patient with a possible STEMI) based on your paramedics assessment of the 12 lead (I am assuming if they can transmit it to you guys, they can send it to the ER too so they can review), what is the benefit to the patient of meeting up with a paramedic, delaying the delivery to the ER, having you guys handle your own assessment, do the driver shuffle, start a line, give some aspirin, and cycle the BP, etc?  

Not saying you guys were wrong, or you should not follow your local protocols;  just something for you to ponder.


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## EpiEMS (May 9, 2022)

mgr22 said:


> Could be any of the above, alone or combined, anytime. In general, women and the elderly are more likely to present with symptoms other than classic ischemic chest pain. It's unwise to rule out an MI based on symptoms alone.



The aphorism I have heard is that for people over 30, any non-traumatic pain between the neck and the navel (probably the groin) gets a 12 lead. Does that track with your practice?


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## mgr22 (May 9, 2022)

EpiEMS said:


> The aphorism I have heard is that for people over 30, any non-traumatic pain between the neck and the navel (probably the groin) gets a 12 lead. Does that track with your practice?


Mostly yes, with some flexibility on location and nature of pain, PMH, and age.


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