Another ALS Call

jeepmedic

jeepmedic

Forum Captain
Messages
451
Reaction score
0
Points
0
51 Year old Male.
S- Chest Pain
A- NKDA
M- Diltiazem, Atenlol
P- HTN
L- Ate Breakfast approx. 1 hour prior to Call
E- Was watching the morning news.

Pt. States that he has never felt like this before. Only History is Hypertension. No Family Hx. of any Heart Problems.

Chest pain is center of chest. Non-Radiating, Skin Cool and Moist, Pt. is Short of breath.
 
jeepmedic said:
51 Year old Male.
S- Chest Pain
A- NKDA
M- Diltiazem, Atenlol
P- HTN
L- Ate Breakfast approx. 1 hour prior to Call
E- Was watching the morning news.

Pt. States that he has never felt like this before. Only History is Hypertension. No Family Hx. of any Heart Problems.

Chest pain is center of chest. Non-Radiating, Skin Cool and Moist, Pt. is Short of breath.
Click to expand...

What are the vitals and physical findings?
 
trauma1534 said:
What are the vitals and physical findings?
Click to expand...

BP- 100/60
P- 36
RR- 28 and labored
LS- Clear and =
No LOC
Eyes PEARL
No JVD
Trach. Midline
ABD soft Non-Tender
MAEW X4 with = Distal pulses
No Edema Noted.
 
jeepmedic said:
BP- 100/60
P- 36
RR- 28 and labored
LS- Clear and =
No LOC
Eyes PEARL
No JVD
Trach. Midline
ABD soft Non-Tender
MAEW X4 with = Distal pulses
No Edema Noted.
Click to expand...

What is the pain like? Does it radiate? Is there any nausea/vomiting? What did the monitor tell you? What are the lung sounds like? What was he doing when it started?
 
trauma1534 said:
What is the pain like?
Click to expand...

Sharp constant pain

trauma1534 said:
Does it radiate?
Click to expand...
No. Stay in the center of the Chest.

trauma1534 said:
Is there any nausea/vomiting?
Click to expand...
Yes

trauma1534 said:
What did the monitor tell you?
Click to expand...
My monitor does not talk.

trauma1534 said:
What are the lung sounds like?
Click to expand...

Clear and =

trauma1534 said:
What was he doing when it started?
Click to expand...

Watching the Morning News.
 
jeepmedic said:
Sharp constant pain


No. Stay in the center of the Chest.


Yes


My monitor does not talk.



Clear and =



Watching the Morning News.
Click to expand...


Well.... is he A&OX4???? Are there any vehicles in the driveway, with by-standers?

Can I say it please??? LOL
 
You learn very well my young padawan. But this is not the case here. Come on people.
 
jeepmedic said:
You learn very well my young padawan. But this is not the case here. Come on people.
Click to expand...

Especially since I am "THE BABY!" aaagggrrrrrrrrrrrrr!
 
Aggravating or alleviating factors, producible pain with palpation, is it pleuritic in nature, what type of past cardiac hx. since they are on Cardizem..? Aggravation and alleviation of symptoms?

Routine ECG, XII lead..is there ischemia, re-entry ST changes, BBB or axis deviation noted? Gallops, clicks, murmurs, carotid bruits? Crescendo or sharp consistent pain?

Past surgeries, treatments, last physician visit & if treatment changes, stress level ?

Treatment: usual oxygen therapy, IV saline lock, ASA and NTG AFTER XII lead, assessing for inferior wall involvement (then tx. would not be NTG). Morphine, Lopressor or ACE inhibitor...

R/r 911
 
without the ekg findings, i would guess pleurisy.

having been in almost this exact same situation myself, only difference being i was 21 not 54, thats the direction i would lean

tx:
all the usual cp goodies
iv-ns
monitor
12 lead if equipped
o2
ntg as appropriate
162-324 baby asa po
 
wait a minute...i missed something. diltiazem....afib

symptomatic afib. pr was 36??? niesh kiet!!
 
Ridryder911 said:
Aggravating or alleviating factors, producible pain with palpation, is it pleuritic in nature, what type of past cardiac hx. since they are on Cardizem..? Aggravation and alleviation of symptoms?
Click to expand...
The only Hx is HTN

Ridryder911 said:
Routine ECG, XII lead..is there ischemia, re-entry ST changes, BBB or axis deviation noted? Gallops, clicks, murmurs, carotid bruits? Crescendo or sharp consistent pain?
Click to expand...
Cardiac Monitor shows Sinus Brady at 36 in lead II. No 12 lead done in field at this agency. (I know it should but they do not have 12 lead on truck)

Ridryder911 said:
Past surgeries, treatments, last physician visit & if treatment changes, stress level ?
Click to expand...

No surgical Hx. Last Physician visit 6 days prior. only Treatment change was to increase Cardizem SR to 120mg from 60mg.

Ridryder911 said:
Treatment: usual oxygen therapy, IV saline lock, ASA and NTG AFTER XII lead, assessing for inferior wall involvement (then tx. would not be NTG). Morphine, Lopressor or ACE inhibitor...

R/r 911
Click to expand...
 
We put him on 15lpm O2, IV access Atropine 1mg, HR goes up to ~60 then back down to 32, another 1mg atropine HR goes up again then falls back to mid 30's. Start Pacing Pt. rate of 80 at 80 ma. Get capture, good HR. BP goes up to 140/78 then we turn the power down on the pacer. go all the way down to 5 ma. Chest Pain goes away (exept for the pacing part.). Find out at the Hospital that Pt. condition was caused by his medication. It took a brand new EMT-B to figure this out. 3 medics on scene trying to figure out why this Pt. was having such a low HR. and an EMT-B just looks at the Med bottles and states what is wrong with him. (Of course being the good medics we were we just said "yea right". Called Medical Control and told the Dr. what we had and we were in route.) Medication was adjusted and Pt. hasent had any more problems.
 
You must log in or register to reply here.
Back
Top