Smoke Screen.....

[fireflymedic]

You are called to the scene of a 21 year old male complaining of general unwell feeling. He states he was fine up until about twenty minutes ago when he started feeling lightheaded and had mild difficulty breathing. It is middle of winter, so he assumed it was just due to the cold air. He looks a little pale and diaphoretic. He is walking around and appears anxious speaking in three or four word sentences. Vitals are as follows:

BP: 108/64

pulse : 110

resp : 24, shallow

med hx : asthma since childhood but not symptomatic , smoker 1 pack day, drinks a beer daily, no illicit drug use - not on any meds

what else would you like to know and where would you proceed from here? I promise there's a unique zebra in here !

[Just Plain Ruff]

did he just turn on his heater?

Where was he before this started?

[emt322632]

Any prescription or OTC drugs? Any drug use besides cigarettes and beer? Family hx of cardiac problems? Lung sounds, heart sounds, any nausea and vomiting? Diahrrea? Stomach pain?

Temperature? Agree with Ruff, what was he doing prior to this?

Let's get a 12 lead, place on O2

[mobey]

I'd like to go straight to the chest for a listen?

[Chief1C]

What was he doing up until twenty minutes ago? Anything that could have resulted in Trauma? Perhaps a good old fashion winter sledding or snow-bound vehicle crash, those nice little hidden surprises that Trauma gives us where the pt looks okay then suddenly crashes..?

[fireflymedic]

Okay, so you assess the guy and note the following :

Lungs: diminished right side - no wheezing, crackles, rales noted

Temp : 99.0

Monitor : sinus tach at 110 - no ectopy

Heart sounds : normal

Denies any nausea, vomiting, family hx of cardiac problems, and herbal or illicit drug use - states also no prescription meds. Also denies any hx of recent trauma. States has been inside most of the day playing his playstation and just went outside for a smoke and when he stood up he felt a pain in his side and had difficulty breathing which didn't resolve so he called you. No bruising or crepitus noted in the chest however, you do note that he has extremely large features for his build. Anything else you'd like to know?

[Chief1C]

How much does he weigh? Spontaneous pneumo? Steroid use?

[Just Plain Ruff]

Okay, so you assess the guy and note the following :

Lungs: diminished right side - no wheezing, crackles, rales noted

Temp : 99.0

Monitor : sinus tach at 110 - no ectopy

Heart sounds : normal

Denies any nausea, vomiting, family hx of cardiac problems, and herbal or illicit drug use - states also no prescription meds. Also denies any hx of recent trauma. States has been inside most of the day playing his playstation and just went outside for a smoke and when he stood up he felt a pain in his side and had difficulty breathing which didn't resolve so he called you. No bruising or crepitus noted in the chest however, you do note that he has extremely large features for his build. Anything else you'd like to know?

Ok, I'm suspecting spontaneous pneumothorax. I had a patient in this nearly exact presentation yet he sat up in bed and felt a pop in his side.

The reason for the diminished lung sounds is that his lung is collapsing.

IV, High flow Oxygen and prep for decompressing the chest.

Let's get going to the ER.

[Arizonaffcep]

I agree...sounds like a spontanious pneumo. However, I would like to know more about the physical description of the Pt.

[Just Plain Ruff]

the big build is what got me thinking pneumo as well as the pain in the side and decreased lung sounds. The guy I had was a amateur body builder, no six packs on him but he was solid.

When he said he felt a pop and we heard diminished lung sounds I narrowed in on pneumo. By the time we got to the hospital I had darted him after he got much worse. He bought a chest tube and 3 days int he hospital and then to home. He did fine. I suspect this guy did fine too. But who knows, the OP usually has some really good snafu's in his scenarios though.