Typical Chest Pain Call

[LAS46]

This was a call that we had a few months ago.

Dispatch: 58 yo female with chest pain
Arrive to find: female seated at kitchen table, SOB, pale, cool, clammy, radiating pain down left arm.

Assessment reveals:

Airway is patent but PT is SOB. Pupils are PERRL, Lung sounds are clear, Skin is pale, cool and clammy. Pain started 2 hours ago. PT was watching TV when the pain started. Any movement makes the pain worse. PT complains of crushing pain. Pain is 8 on a 10 scale. Pain has got worse over the last 30 min. Physical exam does not reveal any injuries.

Vitals are as follows:
Pulse- 100
Blood pressure-148/90

Alergies-NKA
Meds-nitro, lipitor, high BP meds
Past Medical History-angina, hypertension, stints

TX: Gave 3 Nitro, also gave 325mg Aspirin.

Patient Response: no response to 3 nitro administration
ALS: Consideration

(Hospital is 15 minutes away. ALS Available if needed.)

Follow-up with your comments and TX.

 

[TransportJockey]

Has she been doing any travelling or sitting for long periods of time?

 

[EMT11KDL]

This was a call that we had a few months ago.

Dispatch: 58 yo female with chest pain
Arrive to find: female seated at kitchen table, SOB, pale, cool, clammy, radiating pain down left arm.

Assessment reveals:

Airway is patent but PT is SOB. Pupils are PERRL, Lung sounds are clear, Skin is pale, cool and clammy. Pain started 2 hours ago. PT was watching TV when the pain started. Any movement makes the pain worse. PT complains of crushing pain. Pain is 8 on a 10 scale. Pain has got worse over the last 30 min. Physical exam does not reveal any injuries.

Vitals are as follows:
Pulse- 100
Blood pressure-148/90

Alergies-NKA
Meds-nitro, lipitor, high BP meds
Past Medical History-angina, hypertension, stints

TX: Gave 3 Nitro, also gave 325mg Aspirin.

Patient Response: no response to 3 nitro administration
ALS: Consideration

(Hospital is 15 minutes away. ALS Available if needed.)

Follow-up with your comments and TX.

ALS! High Flow o2.

BLS Side, Re do vitals, contact med control and ask for additional Nitro.. Go en-route to Hospital. Lights with NO SIRENS!

 

[LAS46]

PT had not been traveling, and does sit for long periods.

Has she been doing any travelling or sitting for long periods of time?

 

[Shishkabob]

Pulse ox?
Ekg? Humor me
Capnography?
Temp?
Recent bout of sickness?
Smoker?
How are her legs?




Pain on movement drives me pfurther from a cardiac origin, so I wouldn't be pushing for MORE nitro.

 

[EMT11KDL]

Also your in Colorado correct.. I know some agencies with the rule 500 allow you to do 12 leads and IV as a basic.. Did the strip say anything? Are you able to do IV and push front line cardiac meds per Med control?

 

[TransportJockey]

Iv cert doesn't add cardiac meds, and I'm pretty sure ekg cert is just rythym interprets, not twelve lead interpretation.

Also your in Colorado correct.. I know some agencies with the rule 500 allow you to do 12 leads and IV as a basic.. Did the strip say anything? Are you able to do IV and push front line cardiac meds per Med control?

 

[EMT11KDL]

Iv cert doesn't add cardiac meds, and I'm pretty sure ekg cert is just rythym interprets, not twelve lead interpretation.

depends on ur agency.. you might be allowed to do a 12 and send it to the hospital for the doc.. With the meds side it also depends on your medical director and med control...

 

[TransportJockey]

You might be right. I'll look over my old stuff from the agency I worked for in Denver... and I never actually took either class, so I'm a little fuzzy on just how that worked I just know they had me marked down as iv and ekg certified while I was there.

depends on ur agency.. you might be allowed to do a 12 and send it to the hospital for the doc.. With the meds side it also depends on your medical director and med control...

 

[LAS46]

Pulse ox? 92% ra
Ekg? No EKG
Capnography?
Temp? 96.2
Recent bout of sickness? No Known
Smoker? No
How are her legs? Some swelling noted in ankles and feet.

Also your in Colorado correct.. I know some agencies with the rule 500 allow you to do 12 leads and IV as a basic.. Did the strip say anything? Are you able to do IV and push front line cardiac meds per Med control?

Our QRT crew only had Basics w/o IV cert available. Basics are limited on what they can give via IV. I am certified to interpret basic 12 lead but our QRT unit does not have EKG on board.

 

[EMT11KDL]

You might be right. I'll look over my old stuff from the agency I worked for in Denver... and I never actually took either class, so I'm a little fuzzy on just how that worked I just know they had me marked down as iv and ekg certified while I was there.

its been two years since i was in colorado.. I was over on the west side of the state though. I know we could hook up the 12 lead and send it to the Doc. Also, with the meds.. we were able to push front line, but i am trying to remember if it was only if we had a medic with us or if we could do it per Med control..

 

[EMT11KDL]

Our QRT crew only had Basics w/o IV cert available. Basics are limited on what they can give via IV. I am certified to interpret basic 12 lead but our QRT unit does not have EKG on board.

never mind.. guess that is out of the question than. haha

 

[LAS46]

Rule 500

Colorado Rule 500: http://www.dora.state.co.us/medical/rules/500_non_emer.pdf

You might be right. I'll look over my old stuff from the agency I worked for in Denver... and I never actually took either class, so I'm a little fuzzy on just how that worked I just know they had me marked down as iv and ekg certified while I was there.

 

[EMT11KDL]

its been two years since i was in colorado.. I was over on the west side of the state though. I know we could hook up the 12 lead and send it to the Doc. Also, with the meds.. we were able to push front line, but i am trying to remember if it was only if we had a medic with us or if we could do it per Med control..

Well according to the rule 500... Front line is out! ooppppsssss!!!! I miss spoke about the medications...

ADDED: Medications are allowed under section 7.4 and a waiver... Sorry like I said earlier its been over two years since i was in colorado..

 

[Shishkabob]

Well, since we can only run it as a BLS crew since that's what you are, and we have no way to get further objective information by way of ALS tools, there's not much to do.

What does the rest of the physical assessment turn up? Any abnormalities aside from the swelling to legs/feet?

How far is ALS intercept? If it's further then 5-10 minutes, just bypass it headed for the ER. Maybe have the patient on a couple of liters O2 via NC. Nothing else you can do.

 

[Pittma]

Well, since we can only run it as a BLS crew since that's what you are, and we have no way to get further objective information by way of ALS tools, there's not much to do.

What does the rest of the physical assessment turn up? Any abnormalities aside from the swelling to legs/feet?

How far is ALS intercept? If it's further then 5-10 minutes, just bypass it headed for the ER. Maybe have the patient on a couple of liters O2 via NC. Nothing else you can do.

This. With the swelling in the feet, any pain upon gently squeezing the calf of the swollen leg? How about pain upon foot flexion? Any active cancer or medical history I should know about? Yes to any of these, maybe DVTs?

 

[fast65]

As Linuss said, since we can only run as a BLS crew then there's not much else we can do at this point.

Any JVD, jugular reflex, something along those lines? Respiratory rate? Any pain relief with nitro?

 

[LAS46]

As Linuss said, since we can only run as a BLS crew then there's not much else we can do at this point.

Any JVD, jugular reflex, something along those lines? Respiratory rate? Any pain relief with nitro?

No JVD or Jugular Reflex.

RR was 18

Nitro x3 was not effective for any relief of pain.

They physical assessment turned up no other abnormalities. No pain upon palp of legs or feet. Decreased ROM on both feet due to swelling, minor pain. The only recent medical Hx was surgery to place stints.

 

[fast65]

Hmmmm, well I can't really think of anything else that I would do, it seems like all the basics have been covered.

 

[Aidey]

I'm going to get on my soapbox for a minute.

Stent, not stint.

/soapbox