# Case 01



## Chris EMT J (Mar 23, 2022)

You are dispatched to a 60 y/o male CC shortness of breath and chest pain 

BSI scene safe, 1 patient confirmed

SAMPLE: CP & SOB, no allergies, takes meds for hypertension and diabetes. + Additional history shows had cancer 4 years ago but still had radiation every month, last oral intake was 50min prior and that was a muffin, patient was just resting when symptoms started 

OPQRST:  onset, not prevoked, described as a pressure, doesn't radiate, 10/10 severe,  pain started 5 minutes prior to arrival

Vitals: HR 132, BP 189/99, O2 74 on RA, RR 31, BGL 120, Temp 98.6f


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## NomadicMedic (Apr 9, 2022)

ETCO2? 12 lead?


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## Chris EMT J (Apr 9, 2022)

NomadicMedic said:


> ETCO2? 12 lead?


Just a scenerio I made up um the ETCO2 is 34 and 12 lead shows the S1 Q3 T3 pattern.


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## DrParasite (Apr 11, 2022)

lung sounds?  skin color/condition?  no other history, other than cancer, HTN and DM?  need more information


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## Chris EMT J (Apr 11, 2022)

DrParasite said:


> lung sounds?  skin color/condition?  no other history, other than cancer, HTN and DM?  need more information


On this scenerio. Lungs sound clear, white male with no other history.


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## DrParasite (Apr 11, 2022)

ChrisEMTA said:


> On this scenerio. Lungs sound clear, white male with no other history.


warm & dry?  clammy? diaphoretic?  cyanosis?  flushed?  change of color at the nippleline?  

is he tall and skinny or overweight?

what was he doing in the 2 hours prior to this starting?

other possible Diff diagnosis:
pneumonia
spontaneous pneumothorax
traumatic chest injury
hypertensive crisis
new onset Afib
allergic reaction to something in the muffin

so many other options, so much additional information that needs to be added to make this a decent scenario


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## Chris EMT J (Apr 11, 2022)

DrParasite said:


> warm & dry?  clammy? diaphoretic?  cyanosis?  flushed?  change of color at the nippleline?
> 
> is he tall and skinny or overweight?
> 
> ...


Yes to diaphoretic no to the others. He is overweight. Just woke up about 2 hours ago in this scenario and good differential


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## Aprz (Apr 11, 2022)

S1Q3T3 is a sign of right ventricular strain. A lot of students or noobies  associate it primarily or even only with pulmonary embolism. It is neither specific nor sensitive for pulmonary embolisms.

Because pulmonary embolisms creates dead space, lack of blood flow to the lungs to have proper exchange, the patient's end tidal capnography is usually significantly low - if you're sticking to the patient had an end tidal of 34, which is only 1 mmHg from within normal limits. Large pulmonary embolisms can cause obstructive shock leading to hypotension - if you're sticking to a blood pressure of 189/99.

Deep vein thrombosis, which can lead to pulmonary embolisms, is pretty common in cancer. ¿Porque no los dos? 🌮 🌮


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## pikachu (Jun 2, 2022)

vein, in human physiology, any of the vessels that, with four exemptions, convey oxygen-drained blood to the right upper chamber (chamber) of the heart. The four exemptions — the aspiratory veins — transport oxygenated blood from the lungs to the left upper office of the heart. *link removed* The oxygen-drained blood shipped by most veins is gathered from the organizations of minute vessels called vessels by string measured veins called venules.


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## E tank (Jun 2, 2022)

Treat symptomatically as able during transport.


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## E tank (Jun 2, 2022)

E tank said:


> Treat symptomatically as able during transport.


Yikes...sucked into a thread by a robot.....


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## ffemt8978 (Jun 2, 2022)

E tank said:


> Yikes...sucked into a thread by a robot.....


To be fair, when I'm scanning the new forum posts for the day links in a members first post usually raise a red flag.


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## MrBrown (Jun 5, 2022)

His vital signs are significantly abnormal and he has concerning symptoms (severe chest pain and shortness of breath) which require investigation.  Pretty simple.  In the absence of a specific diagnosis with a specific pathway (in this case, for example, STEMI), it is fairly obvious the patient requires transport to an emergency department by ambulance.  Treat symptomatically.

I am going to keep on about this .... why do a BM? Does dysgylcaemia present with severe chest pain, SOB and derangement in vital signs? No, it doesn't.  Every man and his dog does not need a BM done.  That is pointless and unnecessary and shows a lack of judgement.  That is like saying just because someone has asthma, you are going to listen to their chest to see if they have wheeze when there is no other clinical indication to do so.  Or, perhaps because someone has HTN, you are going to take a blood pressure when there is no other clinical indication to do so.


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## Aprz (Jun 5, 2022)

@MrBrown A lot of people here probably aren't familiar with the acronym Boehringer Mannheim (BM) for blood sugar. Usually people will say BM for bowel movement instead. It's pretty common for people to treat blood sugar and lung sounds like vital signs. If you establish an intravenous line, it's extremely common for people to automatically assess the blood sugar before throwing away the sharp. Reliable patients are not very reliable. I think you should have an open mind beyond the patient's complaint. It's very common for patients to withhold important information. It's common for patients to be more concerned with something less concerning. I believe every patient should have lung sounds done and a complete set of vital signs, including blood pressure.


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## Chris EMT J (Jun 7, 2022)

MrBrown said:


> I am going to keep on about this .... why do a BM? Does dysgylcaemia present with severe chest pain, SOB and derangement in vital signs? No, it doesn't.  Every man and his dog does not need a BM done.  That is pointless and unnecessary and shows a lack of judgement.  That is like saying just because someone has asthma, you are going to listen to their chest to see if they have wheeze when there is no other clinical indication to do so.  Or, perhaps because someone has HTN, you are going to take a blood pressure when there is no other clinical indication to do so.


BGL is a routine vital so we do them on everyone. Like some ambulance services so rhythm strips on everyone. And yes with a patient with asthma I will listen to the chest because people with asthma aren't defined as only asthma. I ain't going to miss something like a pneumonia because I get close minded. And I am going to do a blood pressure on everyone because it's important. Patients with hypertension can still get low BPs or have normal BPs which are considered hypotensive for them. Also having stage 1 hypertension with a normal BP of 140/90 I don't want to miss a BP of 220/150 just because I am close minded. It's not safe to be close minded a dissmisive over pmx and S/S


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## E tank (Jun 7, 2022)

It's easier (and prolly less expensive)  than putting oxygen on someone and the cost-benefit ratio  isn't in the same zip code....caught more unanticipated problems with reflexive BG checks than I care to share....goofy patient? No brainer....


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