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- by carleah Nov 26, '11Im' working at a jail and had an inmate come down with chest pain. He has mental issues but cardiac ones too. The MD on call did not answer my call, but I did take an ekg. The automatic reading states accelerated AV junctional rhythm (no atrial activity detected) and states extensive precordial ST elevation, consider acute ischemia.
Is this super serious? I know he's had a stroke several years ago. Do I need to call 911?
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- Nov 26, '11 by akulahawkAt least you got an EKG... While automated EKG machines may spit out something similar to what you posted, learn to read the EKG's themselves. I don't trust the machine's "diagnosis" of the EKG.
As for the rest of it... you should already know the answer by the clinical presentation.
- Nov 26, '11 by carleahThanks for your replies. I think both responses were correct. Clinically, I don't believe it was a real cardiac issue, and yes you can't always trust the ekg printout. I did get an MD finally and he made sure I did a thorough history. Didn't help that the patient had mental issues beside medical ones. Oh well good practice for sharpening my nursing judgement skills.
- Nov 27, '11 by CVmursenaryi think you should learn to interpret a 12-lead if your gonna do one. If you have a 12 lead positive for STEMI and you don't do anything it doesnt look good.
- Nov 29, '11 by CreamsodaIm sorry but why would you be on this website if you had any suspicion the guy was having MI, especially a STEMI. I just don't get it. Know your basic 12 leads. Im not the best with axis deviations and the really advanced stuff, but know the leads, and know when to spot ischemia in those leads. ST elevation, depression ect. And don't be on all nurses asking for advice when your in the middle of a situation. Come on, but I'm sorry, its just plain stupid. OK so your waiting for a call back from the doc, wouldn't you be putting the basics into place? Oxygen and ASA at the very least? Assesing his chest pain in depth. Yes he may have mental issues, but that doesn't preclude him from having an acute cardiac issue and you really need to explore it in depth. So what happened, did he get sent to the hospital, did the doc come see him? I always take chest pain seriously. Often its nothing, and can be chalked up to anxiety, other things, but what if its not. STEMI, PE, dissecting aneurysm at the worst. Pulled muscle, anxiety at the very least. Id like to understand your rationale for posting this here.
- Nov 29, '11 by SummitRNThis website does not offer live medical advice. Please contact someone in your chain of command who can help you or dial 911.
Or be smart enough next time to phrase the question so it isn't so obvious that it is a live request for advice.
- Nov 30, '11 by turnforthenurseRNif you have ST elevation of 1mm in limb leads and 2mm in precordial leads in at least 2 continuous lead sets OR a *NEW* LBBB, you have a STEMI.