An ECG: a case for rapid access to ECG for diagnosis

62 year old male with chest pain and a scary ECG

o A 62 year old male presents to the emergency department with chest discomfort that began over an hour ago

o At registration, he has ongoing chest pain associated with nausea and diaphoresis

o The registration clerk immediately calls for an urgent ECG and alerts the triage nurse

o Within a few minutes, the patient is in the protocol room, hooked up to the ECG monitor

o As the ECG is being done, he loses consciousness

While the latter half of the ECG draws our attention immediately, let’s walk through it from the beginning.

o We don’t have the entire 12 lead, however, the first few beats are sinus rhythm and show ST elevation in leads I and V5. There is also ST depression in lead III.

o This demonstrates a lateral STEMI. Based on the limited leads and beats, it’s difficult to know if there is anterior involvement as well.

o The ECG shows that the rhythm quickly degenerates into ventricular fibrillation (VF)

Key takeaway points

Patients suspected of having a STEMI need rapid access to ECG for diagnosis. In this case, because the health care team acted quickly, the STEMI was diagnosed, and the patient was already in a monitored setting when he had a cardiac arrest.

Have you heard about our Ten Minute Tracing (TMT) project? TMT is an initiative working to improve the suboptimal time we’ve observed from First Medical Contact to ECG (FMC-ECG) in the Winnipeg Emergency rooms. The guideline-recommended time for FMC-ECG is ten minutes. The first site we have partnered with is Grace Hospital. With our help, Grace has reduced these times from a median of 30 minutes to 6 minutes! These shortened times have the potential of saving lives in STEMI patients presenting to our Winnipeg Emergency Departments.

While most STEMI patients are hemodynamically stable, health care professionals always need to think about ABC’s (Airway, Breathing, Circulation), IV access and cardiac monitoring in these patients.