Friday, 23 July 2010

69 year old male CC: "Indigestion"

Here's a case from a faithful reader who wishes to remain anonymous.

In his own words:

Presenting Complaint - Chest Pain

History of Present Complaint - 69 year old male, nil cardiac history, none smoker, social drinker.
Complaining of indigestion last 2-3 weeks with noticably increase in belching.
This a.m acute onset of burning heavy central chest pain radiating to neck.

On Arrival - Semi-recumbent in bed

On examination:
Alert, orientated and communicable (GCS 15)
Pallor
Diaphoretic

Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 16, SpO2 98%

H/R 90 and irregular, Hypertensive 168/110

Temp 36.5 C (97.7 F)
B.M 9.0

C/O chest pain..
O - Acute
P - Nothing makes pain better. Not affected by breathing
Q - Heavy in chest, burning in throat
R - Retrosternal and radiating to neck
S - Pain score 10/10
T - 15 mins
I - No pain intervention sought.

Nil nausea, nil vomit

The cardiac monitor is attached.


A 12-lead ECG is captured.



The patient loses consciousness and the monitor shows ventricular fibrillation. A shock is delivered at 200J.


The patient experiences return of spontaneous circulation.


A few minutes later the heart rhythm returns to baseline.


What is this patient's problem?

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See also:

Chronicles of EMS - "Change the Name" Competition!