Case Study 45 y/o M Inferior Wall STEMI

[Guest guest]

When were the labs drawn and were they repeated and when? What is his

history of tobacco use? Smoker? Snuff dipper? I would bet on variant

coronary

artery spasm (Prinzmetel's Angina) in view of his welding test, since VCAS

can be brought on by stress. Also, did he have any caffein on board?

Any suspicion of non-prescription drug use?

GG

>

> Greetings and Salutations. I have a question for the powers at be on

> an interesting case I ran the other day and was wondering what

> everyone thought of it and if they have ever had a similar case.

>

> Dispatched to difficulty breathing at a local fast food joint. 45 y/o

> hispanic male sitting down fixing to eat his meal and he c/o a dull

> aching pain in center of his chest 8/10 radiating to his back and pain

> in left arm with SOB. He weighed ~80kg, No other complaints. PMH was

> HTN and he took Lisinopril, but possibly not compliant. NKDA and no

> family history. It was difficult to get information from him cause of

> the language barrier. Onset was about 15 minutes before we showed up

> and all he had done was take a welding test earlier and he was fine

> when he initially went inside the restaraunt. From a distance while

> walking in, he looked real pale, diaphoretic, and looked like he was

> having " the big one " and the restaraunt was cold at that time. He

> didn't speak or understand english, so we finally found a guy that

> worked at the restaraunt that spoke pretty decent spanish.

>

> Initial VS were 82/50, HR 68 w/r, RR 20 n/l, SPO2 96% room air, BGL

> 160 mg/dL. Strong, = grip strength, pupils were PEARL, GCS 15, breath

> sounds =, bilateral X 4. Initial 4 lead showed some ST elevation in

> lead II and III, so we did a 12-Lead and it showed an ~3mm ST segment

> elevation in the inferior leads with no reciprocal changes. We were

> unable to obtain a right sided EKG, but at this point, it was

> irrelevant. Called the hospital with information while onscene to

> verify they are able to handle this patient and they said they could.

> It was around 1520hrs when I called.

>

> Loaded him in truck, bolused him about 700cc NS total and did the

> standard ACS treatment WITHOUT giving the ntg and morphine, brought

> him into the ER. Last BP was 116/80. Cath team were prepping him for

> surgery and there 12-Lead showed an inferior wall AMI as well.

>

> After everything was all said and done, I called a tech friend of mine

> that worked there to check on that patient and he said that when they

> went into him, his arteries were clear and his labs were normal. I

> thought he was kidding, but he was serious. He had told me at that

> time, they didn't know what exactly was wrong with him.

>

> I spoke with one of my old instructors about this patient and he said

> that sometimes that happens where the patient has all the S/S and pre

> hospital tests of a STEMI, but when they go into him everything is

> clear. However, he didnt' have any stats on how often it occurs, but

> he did think it may have been one of these three things.

> 1. Had some type of vasospastic spasm

> 2. Had a thrombus that was fixed after the heparin and integrillan

> were given

> 3. Had some type of anomale.

>

> Again, my question is has any one of you heard of or worked a case

> similar to this? Sorry so long, but I do appreciate your input.

> Thanks and stay safe.

>

> -brian-

>

>

**************

Gas prices getting you down? Search AOL Autos for

fuel-efficient used cars.

(http://autos.aol.com/used?ncid=aolaut00050000000007)

[Guest guest]

Greetings and Salutations. I have a question for the powers at be on

an interesting case I ran the other day and was wondering what

everyone thought of it and if they have ever had a similar case.

Dispatched to difficulty breathing at a local fast food joint. 45 y/o

hispanic male sitting down fixing to eat his meal and he c/o a dull

aching pain in center of his chest 8/10 radiating to his back and pain

in left arm with SOB. He weighed ~80kg, No other complaints. PMH was

HTN and he took Lisinopril, but possibly not compliant. NKDA and no

family history. It was difficult to get information from him cause of

the language barrier. Onset was about 15 minutes before we showed up

and all he had done was take a welding test earlier and he was fine

when he initially went inside the restaraunt. From a distance while

walking in, he looked real pale, diaphoretic, and looked like he was

having " the big one " and the restaraunt was cold at that time. He

didn't speak or understand english, so we finally found a guy that

worked at the restaraunt that spoke pretty decent spanish.

Initial VS were 82/50, HR 68 w/r, RR 20 n/l, SPO2 96% room air, BGL

160 mg/dL. Strong, = grip strength, pupils were PEARL, GCS 15, breath

sounds =, bilateral X 4. Initial 4 lead showed some ST elevation in

lead II and III, so we did a 12-Lead and it showed an ~3mm ST segment

elevation in the inferior leads with no reciprocal changes. We were

unable to obtain a right sided EKG, but at this point, it was

irrelevant. Called the hospital with information while onscene to

verify they are able to handle this patient and they said they could.

It was around 1520hrs when I called.

Loaded him in truck, bolused him about 700cc NS total and did the

standard ACS treatment WITHOUT giving the ntg and morphine, brought

him into the ER. Last BP was 116/80. Cath team were prepping him for

surgery and there 12-Lead showed an inferior wall AMI as well.

After everything was all said and done, I called a tech friend of mine

that worked there to check on that patient and he said that when they

went into him, his arteries were clear and his labs were normal. I

thought he was kidding, but he was serious. He had told me at that

time, they didn't know what exactly was wrong with him.

I spoke with one of my old instructors about this patient and he said

that sometimes that happens where the patient has all the S/S and pre

hospital tests of a STEMI, but when they go into him everything is

clear. However, he didnt' have any stats on how often it occurs, but

he did think it may have been one of these three things.

1. Had some type of vasospastic spasm

2. Had a thrombus that was fixed after the heparin and integrillan

were given

3. Had some type of anomale.

Again, my question is has any one of you heard of or worked a case

similar to this? Sorry so long, but I do appreciate your input.

Thanks and stay safe.

-brian-

[Guest guest]

You mentioned a welding test? Any idea what type of welding method, PPE and type

of electrode used... might be poisoning.

& nbsp;

" A prudent man foresees the difficulties ahead and prepares for them; the

simpleton goes blindly on and suffers the consequences. "

Proverbs 22:3

[Guest guest]

Good morning. Thanks for responding. As far as the welding test, it

was a hands on type of welding test and I'm assuming he wore the

appropriate PPE. He said he didn't smoke or do tobacco and I doubt he

did any type of non prescription drug use cause he was very clean cut

and pleasant, but now adays, people will surprise you. Also becasue

of the language barrier, interviewing him was challenging. He was

drinking a soda when we arrived and I'm assuming it was a coke or dr.

pepper.

As far as labs, I " m not sure, but I " m pretty positive they did repeat

labs cause they are a certified chest pain center, but then again,

some places in my opinion are only certified on paper. I'm going to

try to find out later if they found anything on him.

As far as being posioned of any type, I am really not sure cause I

don't know much about welding.

Thanks again.

--

>

> When were the labs drawn and were they repeated and when? What is his

> history of tobacco use? Smoker? Snuff dipper? I would bet on

variant coronary

> artery spasm (Prinzmetel's Angina) in view of his welding test,

since VCAS

> can be brought on by stress. Also, did he have any caffein on board?

> Any suspicion of non-prescription drug use?

>

> GG

>

>

>

> >

> > Greetings and Salutations. I have a question for the powers at be on

> > an interesting case I ran the other day and was wondering what

> > everyone thought of it and if they have ever had a similar case.

> >

> > Dispatched to difficulty breathing at a local fast food joint. 45 y/o

> > hispanic male sitting down fixing to eat his meal and he c/o a dull

> > aching pain in center of his chest 8/10 radiating to his back and pain

> > in left arm with SOB. He weighed ~80kg, No other complaints. PMH was

> > HTN and he took Lisinopril, but possibly not compliant. NKDA and no

> > family history. It was difficult to get information from him cause of

> > the language barrier. Onset was about 15 minutes before we showed up

> > and all he had done was take a welding test earlier and he was fine

> > when he initially went inside the restaraunt. From a distance while

> > walking in, he looked real pale, diaphoretic, and looked like he was

> > having " the big one " and the restaraunt was cold at that time. He

> > didn't speak or understand english, so we finally found a guy that

> > worked at the restaraunt that spoke pretty decent spanish.

> >

> > Initial VS were 82/50, HR 68 w/r, RR 20 n/l, SPO2 96% room air, BGL

> > 160 mg/dL. Strong, = grip strength, pupils were PEARL, GCS 15, breath

> > sounds =, bilateral X 4. Initial 4 lead showed some ST elevation in

> > lead II and III, so we did a 12-Lead and it showed an ~3mm ST segment

> > elevation in the inferior leads with no reciprocal changes. We were

> > unable to obtain a right sided EKG, but at this point, it was

> > irrelevant. Called the hospital with information while onscene to

> > verify they are able to handle this patient and they said they could.

> > It was around 1520hrs when I called.

> >

> > Loaded him in truck, bolused him about 700cc NS total and did the

> > standard ACS treatment WITHOUT giving the ntg and morphine, brought

> > him into the ER. Last BP was 116/80. Cath team were prepping him for

> > surgery and there 12-Lead showed an inferior wall AMI as well.

> >

> > After everything was all said and done, I called a tech friend of mine

> > that worked there to check on that patient and he said that when they

> > went into him, his arteries were clear and his labs were normal. I

> > thought he was kidding, but he was serious. He had told me at that

> > time, they didn't know what exactly was wrong with him.

> >

> > I spoke with one of my old instructors about this patient and he said

> > that sometimes that happens where the patient has all the S/S and pre

> > hospital tests of a STEMI, but when they go into him everything is

> > clear. However, he didnt' have any stats on how often it occurs, but

> > he did think it may have been one of these three things.

> > 1. Had some type of vasospastic spasm

> > 2. Had a thrombus that was fixed after the heparin and integrillan

> > were given

> > 3. Had some type of anomale.

> >

> > Again, my question is has any one of you heard of or worked a case

> > similar to this? Sorry so long, but I do appreciate your input.

> > Thanks and stay safe.

> >

> > -brian-

> >

> >

>

>

>

>

>

> **************

> Gas prices getting you down? Search AOL Autos for

> fuel-efficient used cars.

> (http://autos.aol.com/used?ncid=aolaut00050000000007)

>

>

>

[Guest guest]

There are a number of sites that address fume poisoning. Most of the symptoms

are neuro or respiratory and transient.

" A prudent man foresees the difficulties ahead and prepares for them; the

simpleton goes blindly on and suffers the consequences. "

Proverbs 22:3

[Guest guest]

Good case and well presented.

Yes, vasospasm could definitely cause that scenario. Or thrombus that moved on.

I can't think of what " anomale " your person was referring to--would be

interested to hear.

Were there wall motion abnormalities on the cath? In other words, was the heart

muscle at the inferior portion stunted or limping along?

You could always ask a friendly doc to pull the chart and read the discharge

diagnosis or ask the cardiologist.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

To: texasems-l@...: paramedic352a@...: Wed, 18 Jun

2008 02:38:24 +0000Subject: Case Study 45 y/o M Inferior Wall STEMI

Greetings and Salutations. I have a question for the powers at be onan

interesting case I ran the other day and was wondering whateveryone thought of

it and if they have ever had a similar case.Dispatched to difficulty breathing

at a local fast food joint. 45 y/ohispanic male sitting down fixing to eat his

meal and he c/o a dullaching pain in center of his chest 8/10 radiating to his

back and painin left arm with SOB. He weighed ~80kg, No other complaints. PMH

wasHTN and he took Lisinopril, but possibly not compliant. NKDA and nofamily

history. It was difficult to get information from him cause ofthe language

barrier. Onset was about 15 minutes before we showed upand all he had done was

take a welding test earlier and he was finewhen he initially went inside the

restaraunt. From a distance whilewalking in, he looked real pale, diaphoretic,

and looked like he washaving " the big one " and the restaraunt was cold at that

time. Hedidn't speak or understand english, so we finally found a guy thatworked

at the restaraunt that spoke pretty decent spanish.Initial VS were 82/50, HR 68

w/r, RR 20 n/l, SPO2 96% room air, BGL160 mg/dL. Strong, = grip strength, pupils

were PEARL, GCS 15, breathsounds =, bilateral X 4. Initial 4 lead showed some ST

elevation inlead II and III, so we did a 12-Lead and it showed an ~3mm ST

segmentelevation in the inferior leads with no reciprocal changes. We wereunable

to obtain a right sided EKG, but at this point, it wasirrelevant. Called the

hospital with information while onscene toverify they are able to handle this

patient and they said they could.It was around 1520hrs when I called.Loaded him

in truck, bolused him about 700cc NS total and did thestandard ACS treatment

WITHOUT giving the ntg and morphine, broughthim into the ER. Last BP was 116/80.

Cath team were prepping him forsurgery and there 12-Lead showed an inferior wall

AMI as well.After everything was all said and done, I called a tech friend of

minethat worked there to check on that patient and he said that when theywent

into him, his arteries were clear and his labs were normal. Ithought he was

kidding, but he was serious. He had told me at thattime, they didn't know what

exactly was wrong with him.I spoke with one of my old instructors about this

patient and he saidthat sometimes that happens where the patient has all the S/S

and prehospital tests of a STEMI, but when they go into him everything isclear.

However, he didnt' have any stats on how often it occurs, buthe did think it may

have been one of these three things.1. Had some type of vasospastic spasm2. Had

a thrombus that was fixed after the heparin and integrillanwere given3. Had some

type of anomale.Again, my question is has any one of you heard of or worked a

casesimilar to this? Sorry so long, but I do appreciate your input. Thanks and

stay safe.-brian-