Just ran a call that highlights the importance of 12-lead!
40-something y/o female with sharp substernal chest pain radiating to left arm. Patient denied SOB/DIB. Only hx is high cholesterol and anxiety. She does (did, hopefully) smoke a pack a day. Per EMT first responders, pain was 10/10, with a pulse of 44, and a BP of 90/palp before we arrived. They were concerned, and said that she looked "really sick".
When we arrived, the patient seemed weak, but was A&Ox4, c/o same pain but now 2/10. Vitals = pulse of 72, BP of 130/90, good skin color, and generally looking okay. Initial 12-lead showed a sinus rhythm at 72 with occasional PACs. There was no ST-segment elevation, but T-waves were noted to be inverted in II, III, and aVF.
Patient got oxygen, aspirin, as well as sublingual nitroglycerin, and transport was initiated to a local ER with a cath lab. Transport took only a few minutes and there were no changes in the patient's condition or in my repeat 12-lead...
...until the hospital driveway, when the patient started to clutch her chest, moaning/screaming that the pain was back and 10/10. Almost instantaneously, huge ST elevation developed on the 3-lead screen of my monitor. The 12-lead was repeated and showed 3mm elevation in leads II and aVF, 4mm elevation in III, and 2mm elevation in V5 and V6. Reciprocal changes (ST depression) were noted in V2 and V3.
The patient was given another SL nitro as we exited the truck. The doctor at the desk was notified that this patient was now a STEMI, and immediately activated the cath lab based on the pre-hospital ECG. Their STEMI protocol was started, including nitro, heparin, integrilin, plavix, etc. immediately. The patient was in the cath lab before I finished my report.
I'm hoping to hear the results of the cath later today. As this was an inferolateral infarct, I suspect there was an LCA occlusion. We will see!
