Right sided chest pain

Burritomedic1127

Burritomedic1127

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Get called for mid 50s yo male complaining of 8/10 right sided non radiating dull pressure with increasing shortness of breath on exertion. You find the pt sitting in a chair Alert x 4 Breathing 20 per minute, Strong radial pulses in the 100s, skin is diaphoretic. Sinus tach on the monitor and hypertensive, here's the 12:
 

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Good idea with S1 Q3 T3, thought the same but no.
 
Pt has hx of previous MI, 3 bypass, HTN, and hyperlipidemia

Takes ASA and rate controlled with metoprolol
 
S1Q3T3 is more Cor Pulmonale than just PE. Depression in V5 V6 with elevation in aVR, I'd like to see a right sided 12 lead. Lung sounds? Oxygen saturation?
 
Right sided 12 lead unremarkable (dont have copy) lungs clear in all fields, 92% on RA, jumps to 95% on 2 lpm NC.

Administered 243mg ASA and one sublingual 0.4mg nitro with pain relief and slight improvement of hypertension

Thinking STEMI or no?
 
As a medic student, my first thought was obvious anterior MI? I'd like to see a BGL. Aspirin, nitro, O2 based on sat.

My second thought was that I really need to put more time into studying EKG's over winter break! My third thought was that I'm glad we have telemetry...
 
Not sure where my reply from yesterday went...but to sum it up.

If there is a fever too this scenerio is textbook PE. Not saying it's a slam dunk but that's high on my list.

R sided 12-lead is negative could be NSTEMI. Could be septic too.

She's tolerating CPAP? Good. C3 to cardiac facility, ASA, nitro, and a face mask/gown because it's about to hit the fan.
 
Burritomedic1127 said:
Right sided 12 lead unremarkable (dont have copy) lungs clear in all fields, 92% on RA, jumps to 95% on 2 lpm NC.

Administered 243mg ASA and one sublingual 0.4mg nitro with pain relief and slight improvement of hypertension

Thinking STEMI or no?
Click to expand...

Are you a little dyslexic? :p

I am running on the PE side of things, any recent surgery/trauma/Falls?
 
beano said:
Post op day 3 in original post
Click to expand...
You, like me, are getting the two scenario threads confused. This is a separate one than the CPR in progress thread started by @teedubbyaw. That one does have the 3 day post-op PE deal.
 
beano said:
Haha, so that's where my reply went.
Click to expand...

Strangely your answer works. Pt was treated as a STEMI by EMS. 12 lead transmission, ASA, Nitro. Myself and the med control MD I spoke with were most concerned about the somewhat global non specific depressions with elevations in aVR and V1, with V1>aVR. But cardiology thought different...go figure...and the cath lab was not activated. But he was having an NSTEMI with an ejection fraction about 15%

So beano for the half win??
 
Burritomedic1127 said:
Ahhh I get you. Nah wasn't my dyslexia kicking in haha it was the Pt already took one 81mg ASA prior and we gave 3 81mg ASA to reach our max dose of 324
Click to expand...

Gotcha, I am now picking up what you are putting down, I thought your computer likes to jump to different spaces like mine does when I am trying to type.
 
Happens all the time. If I didn't double check my post earlier, that Pt was starving an NSTEMI.

Professional fat kid status when your autocorrects are food related
 
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