An Interesting Case I Attended To Involved An Elderly Man

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An interesting case I attended to involved an elderly man in his 80s who is a non-smoker and non-alcoholic. He looked grayish, pale and sweaty, which is the typical appearance of a cardiac patient. He presented with chest pain that he gave a pain score of 8/10, and which worsened upon inspiration. He also presented with vomiting and shortness of breath. Electrocardiogram (ECG) indicated a ST Elevation Myocardial Infarction (STEMI). Paramedic believes it was an anterior infarct with elevation in V2, V3, V4 leads and reciprocal depression in Leads II, III and aVF. The patient had several risk factors for heart disease such as high blood pressure, being overweight and living a sedentary lifestyle. He has had chest pain previously, but it was …show more content…

Chest pain was presented in 49.5% of patients with STEMI6. The pain may radiate to arms, neck, stomach or jaw7. There may also be sweating, light-headedness, nausea or shortness of breath8.

In LAS, clinical care of a patient with STEMI focuses on assessment of cardiac pain, administering aspirin, GTN, and analgesia (Entonox or morphine). While there may be circumstances where the full care bundle cannot be provided, all elements are offered whenever possible.

Previously, oxygen was part of the initial care bundle provided for patients with suspected myocardial infarction. However, updated studies suggest that oxygen may cause increased myocardial injury due to coronary vasoconstriction and elevated oxidative stress9. In the Air versus Oxygen in ST-segment Elevation Myocardial Infarction (AVOID) trial, oxygen was administered to patients with STEMI via face mask at 8L/min10. Levels of troponin and creatine kinase, as well as incidences of recurrent MI and cardiac arrhythmia, were assessed in the control group and oxygen group to determine the effects of oxygen on patients with STEMI11. Results showed a significant increase in mean peak creatine kinase and an increase in rate of recurrent MI in the group given supplemental oxygen12. This suggests that oxygen therapy in patients without hypoxia may increase early myocardial injury13. Currently, according to LAS guidelines, only

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