A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index EKG
The patient is a 70-year-old female with a past medical history of hypertension, off of medications, who is presenting for concern of chest pain. The pain radiated to both her neck and back, started at 4 AM, and resolved just 10 minutes prior to arrival in the emergency department. The patient had an EKG (Figure 1) in triage that was immediately brought to the attending for review
Erica Dolph MD and Ari Edelheit MD
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Figure 1. Index EKG
A 74-year-old male with documented 95% stenosis of the LAD in 2021 status post catheterization, HIV well-controlled on Tivicay presents to the ED for intermittent non-exertional, non-pleuritic chest pain that started 2 days ago. The pain is described as non-radiating. He denies any fevers, cough, shortness of breath, lower extremity swelling, abdominal pain, vomiting, diarrhea. He denies prior history of DVT or PE, recent travel, or surgery. Initial vital signs were: BP 163/82, HR 160, RR 20, O2 97% on room air. His EKG (Figure 1) is shown.
Veda Ravishankar MD and Ari Edelheit MD
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A 38-year-old male presents to a community hospital emergency department at 3 a.m. and a rapid response is called to the front of the hospital. You respond, and the patient is alert but diaphoretic, weak, and displaying Levine’s sign (a fist clenched over his chest). His wife states that the chest pain started about 30 min prior to arrival. The patient is brought to your resuscitation bay, and his vital signs are as follows: BP 145/98, HR 99, RR 18, O2 93%. You ask for an EKG when then tech informs you that both of the EKG machines in the ED are broken, and we currently have no way of obtaining a tracing. What do you do in this scenario?
Michael Hohl MD, David Murray MD, and Ari Edelheit MD
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