EMS_Cadet Posted July 14, 2006 Posted July 14, 2006 You and your ignorant EMT partner are restocking the truck when you get toned out for a cardiac call. You mark enroute. Dispatch advises you that you will be dealing with a 70 year old female. You have a 7 minute ETA. You arrive on scene. No hazards present. You are at a residential home. You load everything onto the stretcher and knock on the door. And elderly man opens the door and greets you. He directs you into the living room. You and your partner enter the living room where you see a 70 year old female sitting on a piano bench. She is alert and oriented. Pt. states that she called EMS because she had a, "funny feeling" in her chest. FD reports that a patient has a BP of 90 palp. For some reason, they didn't obtain anything else. :? S - "Funny feeling in my chest" A - No documented allergies. M - Vitamins, Ecotrin, a cholesterol drug and Cardizem. P - "some heart rhythm thing and high cholesterol." L - "I ate some apples as I was cooking the pie." E - "I was baking a pie..Apple pie to be in fact." Onset - "Baking a homemade apple pie. I thought it would go away, but it didn't." Provokes - "No.." Quality - "It feels like my heart is being tickled." Radiation - "The pain is in my heart. No sir, it doesn't go anywhere." Severity - "It's bad...But It's not so bad I'm going to double over." Time - "It started about an hour ago. It hasn't changed during that time." Before you know it, the FD is back in their response vehicle and is driving away... Nearest ED is 14 minutes non-emergent. Begin the scenario kiddies!
chbare Posted July 14, 2006 Posted July 14, 2006 EMS_Cadet, can we get her on O2 and obtain a baseline set of vital signs. Any dyspnea? What does her skin color and condition look like? Lung sounds? Monitor? (O2 sat and cardiac) Can we check the apples out? (carefully) Take care, chbare.
Ridryder 911 Posted July 14, 2006 Posted July 14, 2006 See if that pie is done yet?.. I would also asked what position she was in checking the pie, bent over, carotid bruits, heart tones, etc.. of course as CHBare described, ECG, IV, FSBS, etc.. Have the describe the pain, sharp, dull, palpitations, associated with breathing, producible with pressure?.. It sounds more like palpitations.. How warm is the room, gas or electric oven?.. R/r 911
MrSpykes Posted July 14, 2006 Posted July 14, 2006 O2, Monitor, IV, check vitals, 12-lead, lung sounds, hang a bag give 250cc bolus NS then tko , ask if she took her meds today, get her on the cot sitting up. move her out to the truck. Start making our way in nice and easy.
canuckEMT Posted July 14, 2006 Posted July 14, 2006 In agreement with the above posts, full set of baseline vitals then Pt on stretcher semi fowlers into the unit to do 12lead which I would expect to see A-fib with RVR. First guess to rhythm due to the Cardizem(diltiazem). I would also check lung sounds and for any signs of JVD. With not being able to relieve the pain with position I would also be putting Pericarditis in the back of my mind. Any Hx of cold or flu-like symptoms in the recent past? What was her tympanic temp? Has this ever happened to her before? Any change in pain on palpation? As far as Tx enroute to hosp, she seems to be mentating well so I would start with NC@3 Lpm, saline lock while asking Pt if this is a normal BP for her ( if she knows her normal), If not I would try 1 250 mL bolus and reassess for any changes, also questioning would also include asking Pt if she is diligent with her medications ( not just today but in the recent past as well), check 12 lead and patch findings to hosp, rest of Tx would depend on 12lead findings and Pt presentation.
EMS_Cadet Posted July 14, 2006 Author Posted July 14, 2006 EMS_Cadet, can we get her on O2 and obtain a baseline set of vital signs. Any dyspnea? What does her skin color and condition look like? Lung sounds? Monitor? (O2 sat and cardiac) Can we check the apples out? (carefully) Take care, chbare. You got the 02... BP is 134/86. Pulse rate is 175. RR is 24. Pulse ox is 99% on o2. No dyspnea. Skin color/temp is normal. No diaphoresis. Lung sounds are clear and equal B/L. Apples are fine and dandy...Nothing that would suspect anything...And don't worry, a careful inspection was completed. Rhythm strips (including 12 lead) are as follows: Click here for the rhythm strips
EMS_Cadet Posted July 14, 2006 Author Posted July 14, 2006 See if that pie is done yet?.. I would also asked what position she was in checking the pie, bent over, carotid bruits, heart tones, etc.. of course as CHBare described, ECG, IV, FSBS, etc.. Have the describe the pain, sharp, dull, palpitations, associated with breathing, producible with pressure?.. It sounds more like palpitations.. How warm is the room, gas or electric oven?.. R/r 911 The pie is DONE! She just bent over to check the pie. Nothing abnormal occured as she bent over. This "funny feeling" started before the baking. She thought baking a pie would help. :roll: Pt. states: "This is not a pain, but a funny feeling. It's quite odd. I had this several years ago, but I don't remember the name of the condition." The pain does not change with inhalation/exhalation. The room is normal in temp. Electric oven.
vs-eh? Posted July 14, 2006 Posted July 14, 2006 I agree, does this feel like palpitations or like her heart is pounding? Looks like PAT (I can see P waves in the otherwise unremarkable 12-lead,). Even though I'll assume she has a Hx of afib (but it looks pretty damn regular rate aside), there is no WPW present. We don't carry anything to give to that (unless you want to use adenosine as a diagnostic agent, which I don't think I would). Technically she is an "unstable" tachycardia (Chest discomfort), but realistically she appears hemodyncamically stable (no CHF, everything else jives). Has she been compliant with her diltiazem? How long has she been on it for? Give ASA...Trial vagal maneuvers if you are comfortable, and trial diltiazem...She needs rate control.
EMS_Cadet Posted July 14, 2006 Author Posted July 14, 2006 I agree, does this feel like palpitations or like her heart is pounding? Looks like PAT (I can see P waves in the otherwise unremarkable 12-lead,). Even though I'll assume she has a Hx of afib (but it looks pretty damn regular rate aside), there is no WPW present. We don't carry anything to give to that (unless you want to use adenosine as a diagnostic agent, which I don't think I would). Technically she is an "unstable" tachycardia (Chest discomfort), but realistically she appears hemodyncamically stable (no CHF, everything else jives). Has she been compliant with her diltiazem? How long has she been on it for? Give ASA...Trial vagal maneuvers if you are comfortable, and trial diltiazem...She needs rate control. Pt. has been compliant with her meds. Anyone want to see the rythm at a slower rate?
vs-eh? Posted July 14, 2006 Posted July 14, 2006 Anyone want to see the rythm at a slower rate? Go Go Go Go Go...(I'm gonna say now it's atrial flutter just because of the build up *pops collar*). :rr:
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