Thursday, 4 November 2010

47 year old female CC: Chest pain

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

EMS is dispatched to a 47 year old female complaining of chest pain.

On arrival paramedics find the patient seated on the floor. She appears acutely ill. Her skin is cool, pale, and diaphoretic.

The patient confirms that she is experiencing severe, sub-sternal chest discomfort.

Onset: 15 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: "Very bad" (language barrier)
Radiate: The pain does not radiate
Severity: 8/10
Time: No previous episodes

She is also complaining of palpitations.

First responders initially suspect symptoms of anxiety based on her young age.

The patient's son relates that the patient is a diabetic and hands paramedics a bottle of lisinopril and glipizide.

Paramedics ask the patient if she has a history of heart problems. She says "yes" but can not give specifics other than "blood pressure."

Due to the patient's poor appearance the EMS crew immediately loads her for transport.

In the back of the ambulance vital signs are assessed.

RR: 18
HR: 80
NIBP: 240/120 (confirmed with manual BP)
SpO2: 97 with NRB @ 15 LPM

Breath sounds are clear bilaterally.

The cardiac monitor is attached and a 12-lead ECG is captured.

What is your impression and what should the EMS crew do next?