JANUARY 2016 CASE STUDY

HPI

You and your partner are working on an ALS rig in an urban setting. You’re dispatched to a breathing problem at a private residence for 35yom complaining of shortness of breath and “stabbing” chest pain on the right side that is not exacerbated by palpation or deep inspiration. The patient states that he had an acute onset of chest pain approximately two hours ago while he was at rest, and it progressed into severe dyspnea. The patient is ambulatory on your arrival, appears markedly anxious, and is mildly dyspneic.

MEDICAL HISTORY

  • COPD
  • DVTs/PE
  • Cardiac Arrest due to PE
  • Four cardiac stents
  • Diabetes

MEDICATIONS

  • Lantus
  • Novolog
  • Lisinopril
  • Metoprolol
  • Clopidogrel
  • Albuterol
  • Symbicort

ALLERGIES

  • Penicillin
  • Vicodin
  • Morphine

ASSESSMENT

  • Strong, regular, and rapid radial pulses
  • Skin is warm, pale, and dry
  • Respirations appear mildly dyspneic
    • L/S reveal mild expiratory wheeze in the R upper lobe, and clear but diminished in the L side
    • Respirations of 28; 4-5 word sentences
  • Pupils PERRL
  • No obvious trauma noted
  • Patient is a GCS

VITAL SIGNS AND DIAGNOSTICS

IMG_20160105_154713

IMG_20160105_154732

  • BP: 180/132
  • HR: 124
  • RR: 28/mildly labored
  • SpO2: 98% R/A and 99% on NRB @15lpm
  • Blood glucose: 285mg/dl
  • EtCO2: 39
  • Dyspnea does not improve with NRB

Are you suspecting more of a cardiac or respiratory presentation? Combination of both? 

What interventions would you do for this patient? 

 

 

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