Paramedic Education at Monroe Community College, Rochester, New York
You are called to the home of a 62 year old white male c/o a dull ache in his left arm. He is Cx and alert, is in good health and does not take any medications. He has no allergies to medications. The ache has been present for 1 hour now and nothing makes it better or worse. He says it might be a pulled muscle from golfing yesterday. He is a nonsmoker, has no family history of early coronary disease, and says that his BP and colesteral were normal 6 months ago at the Dr's office.
Vital signs: Skin - cool & diaphoretic. BP - 120/78. P - 75 and regular. R - 18 lungs clear. BG - 130 mg / dl. SpO2 - 99% on room air. Temp 99.2 F
You place him on 6 lpm of Oxygen by NC and evaluate the EKG and reassess vitals - They are unchanged from the previous set. You place an IV saline lock, and prepare for transport.
Your interpretation of the EKG and your next step should be:
a) Septoanterolateral wall MI - Aspirin, nitro prn for pain or pressure, continuous cardiac monitoring, expeditious transport.
b) DMI - Withhold nitro until fluid loading of 500 cc NS is established, then nitro prn for pain.
c) Normal EKG - No additional treatment is warranted, transport to ED.
d) Posterior wall MI - Aspirin, Morphine for pain or pressure, Lidocaine 100 mg IV prophylactically and a 2 mg/min drip.
e) Patients EKG shows a LBBB so it can not be used to rule in AMI - Transport as fast as possible.
Updated: February 26, 1998