It’s around 10 pm on a warm summer evening, and you and your partner have answered a steady stream of non-emergency calls all evening. Falls, small lacerations, and minor illnesses have all seen the attention of your ambulance. None of which, however, required the attention of am emergency room, and were handled by the family by the time you arrived. The next call sounds more serious though.
“… respond to a ten charlie one, 52 year old male with chest pain, at…”
Chest pains usually warrant a transport, and usually get them. With high incidences of cardiac disease, diabetes, obesity, and hypertension in your jurisdiction typically when a chest pain gets sent out, it is guaranteed a trip to the nearest emergency room.
You arrive at a well known regular’s house to find him seated on the couch, huffing and puffing away. He claims a history of COPD, which prompts a quick listen of his lungs. Clear, yet the rate is higher than normal, estimated somewhere in the low thirties just on a quick listen. He says that he has had this pain for several weeks, and states that it is probably related to him hitting his chest when he fell several weeks ago. He is insistent on not going to the hospital. At very least, you convince to come out to the ambulance where you can have some better light and look at him more closely. He complies, gets on the cot, and is moved outside to your waiting unit.
After a quick line of question, you break down his story and he admits that he hasn’t had the pain for a week, it has been closer to an hour. He describes it as “pressure,” localizes it mid-sternal without radiation. He rates that pain as 9/10 on a 0 to 10 scale. He says that he was “out chasing whores” when the pain started (strange, I know) and that he came inside having shortness of breath. He denies nausea or vomiting and has an extensive traumatic injuries and family history of cardiac disease.
His vitals are BP 120/80, HR 82, spO2 100%, RR now 22 and falling. No edema is present. Pt denies alcohol or drug use. No accessory muscle use is noted. Skin is warm and dry without signs of cyanosis. No obvious trauma is present. The pain is not reproducible on palpation, no crepitus is noted on palpation. Barrel chest is noted, confirming patient’s story of COPD history, possibly being emphysema. The abdomen is unremarkable, soft and non-tender to palpation. The patient ambulated with a steady gait and says that sometimes he gets “out of breath” with exertion. Pt denies any previous MI’s.
An initial 12 lead is captured with excellent data quality, showing a normal sinus rhythm and large peaked T-waves in septal and anterior leads. The computerized interpretation comes back as normal sinus rhythm with possible early repolarization.
What are your thoughts?
Do you agree with the computer interpretation? Why or why not?