bad day

[p3medic]

Called to a multi-family apartment complex for a 45 yo female complaining of chest pain....

[spenac]

HFS - Hysterical female Syndrome

Yes I'm good I know it. :twisted:

Ok for real. Scene safe, no gas leaks, no CO2, etc?

How does patient describe it including how she has her hands?

What are her vitals?

Skin color, skin temp, etc?

EKG, 12 lead?

Medical HX?

Allergies?

[pguy280]

hmm multy family spells chest pain for providers.These residences usually comes with 3rd floor carry down..

More info please as suggested by Spenac

[p3medic]

The scene appears safe, she is in a top floor apartment of a brick tenement in a densely settled neighborhood of multi family brick apartments, no odor of gas, gun wielding maniacs (in sight), or other obvious hazards.

She is sitting on a couch, wailing in pain clutching her chest. She can't describe the pain beyond it hurts "a lot".

Vitals are hr 52, rr 20, spo2 97% ra, bp 96/62

Skin is warm, slightly diaphoretic with good color.

12ld shows a sinus bradycardia in the 50's with LVH, no ectopy.

Hx is for HTN, poor compliance with rx and IVDA, heroin specifically.

NKDA.

[rock_shoes]

What are the patients prescriptions? Breath sounds (if you can get her to quite wailing long enough to have a listen)? Anything pertinent found on palpation? Other drug use? When was the patients last drug usage? Any other complaints? Patients last ins and outs?

[p3medic]

Pt is prescribed lisinopril, norvasc, trazadone, and hydrocodone, however is poorly compliant. Breath sounds are clear and equal, no jvd noted. Chest wall palpation does not reproduce or change the patients pain. She admits to only heroin use, denies cocaine, her last heroin was approx 40 minutes prior to onset of pain, intravenously. Pt has no other complaints, has been in relatively good health as of late, last meal this am, in fact was eating fruit this am when pain began. No nausea, vomiting, diarrhea or recent illness.

[pguy280]

???What type of fruit was it. Spiders and other insects have been found in grapes and bananas. Also have heard of reactions with taking rescription meds and citrus. But believe these were organ transplant resipents.

[spenac]

She admits to only heroin use, denies cocaine, her last heroin was approx 40 minutes prior to onset of pain, intravenously.

Oops, did she get some pure uncut or not cut as much as usual heroin?

[FozMedic]

I understand that the patient is somewhat non compliant with her medications, however I would still like to know when they were last taken, and at what dose.

I would also try and get some more information about the pain if possible, ie. PQRST.

I would also ascertain whether the heroin that was taken came from a regular supplier, or if it was something new that she had not taken before.

Due to her being on hypertension medication, I find the blood pressure significantly lower than expected, however this could be caused by the heroin use.The bradycardia can also be attributed to heroin, due to the depressant effects of opioids. If however the drug use was the main factor for both the hypotension and bradycardia, I would have expected a decrease in respirations aswell, which has not yet occured.

At this point, my brain is fried....

I'll have a bit more of a think, and get back to you...

Thanks for reading.

[Timmy]

Is she using lisinopril and norvasc as antihypertentives or is there a previous cardiac history or history of CCF? When was the last time she had hydrocodone? Why is she taking hydrocodone, for pain or in conjunction with trazadone? Apart from shooting up what was she doing upon onset? Sitting in the chair? Running up the stairs? Does the pain increase on inhalation? Pain located anywhere else? Did she get the drugs through the usual dealer, take the same amount as usual? She's double dipping on opioids lol