Sunday, 21 February 2010

68 yom CC: Chest Pain

Here's another great case submitted by Robert Bees.

EMS is called in the very early morning to a 68 year old male complaining of chest pain and shortness of breath.

On arrival, the patient is anxious and appears acutely ill. He is oriented to person, place, and time.

Skin is cool, pale, and diaphoretic.

The patient feels light-headed and admits to nausea but has not vomited.

Onset: While sleeping
Provoke: Nothing makes the pain better or worse
Quality: Poorly localized heavy pressure
Radiate: The pain does not radiate to the arms, back, neck or jaw
Severity: 8/10
Time: Patient states he occasionally "feels bad" but "not like this"

Past medical history: MI with stents x 2 years ago.

Medications: ASA, Lipitor, Tenormin, NTG

Patient states he took NTG x 1 prior to EMS arrival which made him "feel worse"

Vital signs:

Resp: 22 shallow
Pulse: 140
BP: 88/54
SpO2: 92 on RA

Breath sounds: rales - patient becomes very light-headed sitting up

The cardiac monitor is attached.

A 12-lead ECG is captured.

What now?