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Cardiac Chest Pain?


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19 replies to this topic

#1 FireEMT2009

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Posted 09 February 2013 - 06:49 AM

Dispatch: Caller states that his father is experiencing chest pain.

 

You arrive to find a 30 year old male meeting you at the door saying his father is having terrible chest pain please hurry!

 

Your patient is a 54 year old male patient. You find your patient sitting in his recliner holding his chest, the patient appears anxious. He says he has never had this chest pain before but needs you do something, he thinks he is having a heart attack. Who's on first?


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#2 Kiwiology

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Posted 09 February 2013 - 08:23 AM

Has he ever had pain like this before? 

Does the pain go anywhere apart from in his chest?

What type of pain is it? sharp? stabbing? cramping? 

How bad is the pain? 

 

Does anything make the pain better or worse?

What is his past medical history like?

Does he have any family history of heart disease?

When did he last eat?

 

Ix - obs and 12 lead ECG including V4R, right sided or posterior leads as appropriate?

Does physical exam reveal anything? lung sounds? heart sounds? JVP?

 

PDx - myocardial ischaemia until proven otherwise 

DDx - MSK pain, spontaneous pneumothorax, trauma, PE, chest infection, pneumomediastinum, AAA, acute ventricular aneurysm, acute valve rupture, pericarditis/myocarditis, epigastric pain, GERD


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#3 island emt

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Posted 09 February 2013 - 02:10 PM

Pt HX , eval , vitals, orthostatic BP, quick 12 lead while stretcher/ stair chair is being brought in

325 mg ASA if no contraindications , O2, IV access, NTG if indicated,& not taking the magic blue boner pill,  put his butt on the stretcher, get in the office and start heading towards definitive care while doing all the above. We have a thirty minute ride to small hospital and hour plus to cath lab if determined by diagnostic review and evaluation.

Today with the weather might take a couple hours due to whiteout conditions just to get to the local hospital.

 

If your in the big city with a cardiac center on almost every street corner. stay in the house and play with all the toys as your transport time is only three minutes.


Edited by island emt, 09 February 2013 - 02:11 PM.

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#4 Arctickat

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Posted 09 February 2013 - 03:36 PM

pericardit......awww screw it.


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#5 island emt

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Posted 09 February 2013 - 09:01 PM

I actually got to see a case of pericarditus the other day trevor. Wasn't my patient , but the ER doc had us all look at the 12 lead to see if we picked up on it..


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