EC Initial Assessment

Emergency Centre Initial Presentation: A 58-year-old, female, presenting with sudden-onset severe chest pain, presented to the Emergency Department via ambulance following a sudden onset of crushing chest pain at home. EC Triage and Initial Observations: Triage Category: Resuscitation (Category 2, Urgency Level: High). Mode of arrival: Ambulance. Initial Vital Signs: BP 160/95 mmHg, HR 110 bpm, RR 22 bpm, SpO2 94% on room air, Temp 37.2°C. Presenting behaviours: Patient is pale, diaphoretic, and clutching her chest, visibly distressed. Presenting Complaint: Patient reports sudden onset of severe, crushing chest pain approximately 2 hours prior to arrival. Pain is retrosternal, radiating to the left arm and jaw. Severity rated as 9/10. Associated with shortness of breath, nausea, and lightheadedness. Onset was at rest while watching television. History of Presenting Illness/Injury: Pain started suddenly and has been constant. Denies any recent trauma or exertional activity. Reports feeling increasingly breathless and nauseous. Pre-hospital care: Paramedics administered aspirin 300mg orally and GTN spray sublingually, with minimal relief. Denies vomiting. Aggravating factors: Deep inspiration. Relieving factors: None noted by patient or paramedics. Past Medical and Surgical History: History of hypertension (diagnosed 5 years ago, poorly controlled), hyperlipidaemia (diagnosed 3 years ago, on statin therapy), and Type 2 Diabetes Mellitus (diagnosed 10 years ago, managed with oral hypoglycaemics). No past surgical history. No known mental health diagnoses or recent admissions. Medications: Regular medications: Ramipril 10mg OD, Atorvastatin 40mg OD, Metformin 1000mg BD. Patient confirms compliance with these medications. No over-the-counter or complementary therapies reported. Allergies: Known allergy to Penicillin (rash and hives). No known food or environmental allergies. Social History: Lives at home with her husband. No reported alcohol or drug use. Smokes 10 cigarettes per day for 30 years. No safeguarding concerns identified. Fully mobile and independent with ADLs prior to presentation. Cognitive status: Alert and oriented to person, place, and time. Clinical Examination: General appearance: Anxious, pale, and diaphoretic. Neurological status: GCS 15. Pupils equal and reactive to light. No focal neurological deficits. Vital Signs (repeat): BP 155/90 mmHg, HR 105 bpm (regular rhythm), RR 20 bpm, SpO2 96% on 2L O2 via nasal cannulae, Temp 37.1°C. Cardiovascular: Tachycardia, S1S2 heard, no murmurs, gallops, or rubs. Peripheral pulses palpable and symmetrical. Respiratory: Bilateral clear air entry, no wheezes or crackles. Abdominal: Soft, non-tender, non-distended. Bowel sounds present. Skin: Cool and clammy to touch. No rashes or lesions. Investigations: Reviewed: Pre-hospital ECG showing ST elevation in leads II, III, aVF. Ordered: Cardiac enzymes (Troponin I), FBC, U&Es, LFTs, Glucose, Coagulation screen, Repeat ECG. Bedside diagnostics: Capillary blood glucose 8.5 mmol/L. Clinical Impression: Working diagnosis: Acute Inferior Myocardial Infarction. Differential diagnoses: Aortic dissection, Pulmonary Embolism, Pericarditis, Oesophageal spasm. Plan: Treatment initiated in ED: Oxygen therapy (2L via nasal cannulae), IV access established, Morphine 2mg IV for pain relief (repeated once for a total of 4mg), Metoclopramide 10mg IV for nausea. Specialist consults: Cardiology registrar consulted, awaiting review. Admission planning: Preparation for admission to Coronary Care Unit. Pending investigations: Awaiting results of cardiac enzymes. Further management to be guided by Cardiology.