You and your partner are working for an Urban ALS service. You are dispatched to non-emergent abdominal pain for a roughly 50 yom at a private residence. The pt states that approximately an hour ago, he was sitting at rest watching t.v., when he felt a “tearing” pain in his lumbo-sacral back. The pt states that since then, he has been feeling “lightheaded” and “dizzy”. He is lying supine on his bed and is very drowsy.


  • Pt is a GCS of 15
  • Skin is Cool, Ashen, and Diaphoretic
  • No radial pulses present bilaterally
  • No obvious trauma noted
  • Resp appear rapid, shallow, and unlabored with no audible B/S


  • BP: 60/30HR: 72/reg
  • Resp: 24
  • Pain: 10/10 with movement; 0/10 while lying still
  • BGL: 164 mg/dl
  • EKG: NSR w/no ST segment abnormalities; occasional PVCs


  • Community hospital – 3 mins away
  • Level II Trauma/PCI Facility- 15 mins away


Where do you go? What do you do?

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