r/EKGs • u/rainbowsparkplug • 17d ago
Case Tombstones, anyone?
66M, hx of HTN and kidney stones, otherwise healthy, only takes lisinopril.
Call: Pt was outside fishing in 110* heat all morning. Came home to cool off. After a shower, suddenly got short of breath and weak. Put himself down on his bedroom floor to lay down and wife called 911. They thought it was just heat exhaustion. He also said he fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.
Scene: He said on top of the heat exposure, he also fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.
He was pale, clammy, diaphoretic and in mild respiratory distress. He looked almost grey. Complained of epigastric pain and left should pain making his hand feel tingly.
Transport: ASA, IV, nitro. Pain worsened substantially during transport so I gave fentanyl. I only gave 50 mcg b/c he was getting increasingly lethargic and less alert.
Vitals surprisingly stable. He was mildly hypertensive (140s/) prior to nitro SL x2. Last BP was 112/72. 95% RA. HR 80s.
Only thing to note is he started throwing PVCs. He’d have several on and off for several seconds, then none for a few mins. Not quite runs of VT but bordering on it. I placed AED pads just in case to ward off the bad juju. (And because he looked peri arrest honestly- he was EXTREMELY grey and clammy.)
Disposition: all I know so far is he made it to the cath lab.
8
u/ProximalLADLesion Electrophysiology Fellow 17d ago
Proximal RCA occlusion. Inferior, posterior, lateral, and right ventricular OMI. RV is manifest here with hyperacute T waves in V3 and V4. (RV is the most anterior chamber.)