Chest pain with head trauma

SunshineCamo

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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.
 

NomadicMedic

I know a guy who knows a guy.
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There are only three things that'll put you on the ground. Your head, your heart and your sugar. :)
 

RedAirplane

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

SpecialK

Forum Captain
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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.
 

ERDoc

Forum Asst. Chief
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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

Forum Lieutenant
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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.
 

ERDoc

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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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