07 Nov

Week of November 10, 2019

Your patient is a 76 year old female who is experiencing shortness of breath.

1. List 3 serious conditions which could be responsible for her shortness of breath.

Answer

1. Pulmonary embolism
2. Acute myocardial infarction
3. Pulmonary edema
4. Sepsis
5. Pneumonia
6. COPD / asthma

You record the following ECG. (Right click on the image, then select “Open in new window” to enlarge)

05062014

What is your interpretation of the ECG?
Answer

Rhythm – normal sinus rhythm
Axis – normal axis
Chamber size – none
Conduction problems – none
Ischemia – anterolateral STEMI; reciprocal ST depression III, aVF
Miscellaneous – none

What are your treatment priorities?
Answer

1. Notify receiving facility “STEMI Alert!”
2. Administer ASA
3. Place combo pads
4. Begin transport to cardiac intervention center
5. Gain vascular access
6. Transmit ECG
7. Administer NTG
8. Notify / consult
9. Obtain additional traces

What should you anticipate with this patient presentation?
Answer

Patients who present with anterior wall STEMI are at high risk for developing ventricular dysrhythmias, sudden cardiac arrest, and pulmonary edema. Be prepared to aggressively treat with electrical therapy and CPAP, respectively. Be sure to notify the receiving facility early and continuously monitor the patient’s mental and respiratory status, cardiac rhythm, and vital signs.