58 Year Old Male, Workout Worry

 

Your Paramedic crew is called to the home of a 58 year old male, “possible heart”

Upon arrival to the home, you are greeted by the gentleman’s wife, who directs you to your patient. You find him sitting in a chair in the living room, appearing concerned, but in no serious distress.

He tells you that while he was excercising on his treadmill, he experienced sudden onset of chest discomfort in the middle of his chest, described only as “pain”. He also tells you that is right arm started hurting at the same time, with some “pins and needles”.  Almost as an afterthought, he tells you that he immediately stopped exercising when the pain started, but continued to have a “cold sweat” and became nauseous.  He adds that he feels a bit better now.

His wife tells you that normally he would have waited to see how he felt, but they had just attended the funeral of a friend the previous day who died of sudden cardiac arrest, and that was fresh on their minds so they called 911 immediately.

He denies any shortness of breath or lightheadedness. No previous episodes like this, and his history is significant only for hypertension.

Vitals are as follows:

  • BP:    150/98
  • HR:    74
  • RR:    20, Lungs clear, SpO2 98% RA
  • Skin: now warm and moist, and a little pale

 

Here are the 12 leads, standard and right sided:

 

 

What do you think?

Would you activate the cath lab?

How would you treat this patient on the way to the hospital, which is 30 minutes away?

 

 

 

 

 

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Author: David Baumrind

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