itku2er Posted July 8, 2008 Share Posted July 8, 2008 You are called to a 58 yo female having CP Upon arrival you find a female sitting in a chair with her feet up. She stated I sneezed and my chest started hurting. Allergic: PCN Codiene Lopressor Sea food and nuts. BP was 130/84 mmHg, pulse was roughly 96-100, respirations were 24, skin was slighly pale diaphoretic, pupils normal. Link to comment Share on other sites More sharing options...
mshow00 Posted July 8, 2008 Share Posted July 8, 2008 Ask her to describe pain location and type-pain on 10 scale, History? Smoker/Drinker? current medication(inc diffenative answer to BC in use), SAMPLE-OPQRST? Fast 12 lead, O2 2-4LPM, IV 18 GA NSLock if possible 20 Ga NS Lock if not, condsider Nitro &/or ASA (depending on pts answers and 12 lead) Link to comment Share on other sites More sharing options...
firedoc5 Posted July 8, 2008 Share Posted July 8, 2008 Possible vagal reaction to sneeze? But it might not be something that simple. Link to comment Share on other sites More sharing options...
Paramagic14 Posted July 8, 2008 Share Posted July 8, 2008 has this ever happened to her before and if so was she treated and what was the outcome. has she had any hx of recent chest trauma/rib fractures,something of that nature...maybe the sneeze caused more musculoskeletal pain or maybe the sneeze just happened to come on the same time as a cardiac event. Link to comment Share on other sites More sharing options...
sevenball Posted July 8, 2008 Share Posted July 8, 2008 tell her to get over it, clear with a signed refusal... Kidding... Certainly isn't that simple. You could be faced with a cardiac problem (all non traumatic chest pains are cardiac until proven otherwise), You could also be faced with a pleuritic pain from the sneeze, you could also be faced with an aortic separation (although rare and highly unlikely), but you never know. I worked with a guy that fractured a cervical vertebrae because he sneezed too hard. the body is funky like that. Link to comment Share on other sites More sharing options...
chbare Posted July 8, 2008 Share Posted July 8, 2008 Past medical & surgical history? Does she smoke or have any type of chronic lung disease? Where is the pain and what does the area look like? Palpate and find out what causes or reproduces the pain. Lung sounds and pulse oximetry? XII lead? Try to rule out or identify pneumothorax. Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 8, 2008 Share Posted July 8, 2008 What are heart sounds like? Does pain increase with deep respirations? Pain radiating? Throat/ laryngeal pain? What's her sign? Link to comment Share on other sites More sharing options...
Jessi Posted July 8, 2008 Share Posted July 8, 2008 (Before you say anything, this call was one I ran, Terri just posted it for me. Bash me if you want, I don't usually pay attention to that stuff) ok, here we go. she says "the pain is kinda in the center of my chest but its also in my left chest. and my shoulder and arm hurts too." she rates the pain a 6 or 7 on a 10 scale. no past medical history, doesnt smoke or drink. S-chest pain radiating to left shoulder and arm A- As listed above M- none other than epi which she carries with her. P-nothing other than an allergic reaction several years back. L- about 6 hrs before the onset of the pain E-she was watching t.v., sneezed, and the pain started. O- after sneezing P-nothing seems to help the pain. Q- mostly constant pain, sometimes the pain fades from her arm but only for a minute or two R- starts in center/left chest, radiates to the left shoulder and arm S-6 or 7 on 10 scale (for the 8th time) T-no pain until she sneezed, about 20 minutes prior to your arrival on scene. No history of trauma to the chest or ribs, No history of surgeries of any kind. No cardiac history no family history of cardiac problems, etc. Chest seems normal, you note no deformities, bruising, or signs of trauma. Palpation cause no visible changes in pt. she states its getting a little harder to breathe. Pulse Oximetry is 96% room air. Pain only gets slightly worse with deep breaths. No pain in the throat or neck. here is your 12 - lead: Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 8, 2008 Share Posted July 8, 2008 HOLY CRAPOLA BATMAN, That just shouts MI MI MI MONA, IV, transport to cardiac center, and whatever else your protocols dictate. Early notification to the chest pain center is key here. . Prepare for patient to crump. Link to comment Share on other sites More sharing options...
chbare Posted July 8, 2008 Share Posted July 8, 2008 Going off of the XII lead I note inferior wall ST elevation. What looks to be reciprocal changes in the other leads make me suspect posterior wall involvement. This may be a proximal RCA occlusion. The PDA would be involved as well. Was a V4R performed and a V7, 8, & 9? Suspect RVI as well. Hold off on NTG, beta blockers, and morphine. In fact, hold off on anything that will decrease preload. fentanyl would be a good consideration for the pain. What are the lung sounds and do we have JVD? We need large bore IV access and have the pacer pads applied. The nodes are at high risk for buying the farm with this type of MI and we may need to anticipate TCP. With that, allow me to ask a few other questions? -Hoarse voice noted? -Differences in blood pressures in the extremities? -Distal pulses present in all extremities? I have seen a couple of dissections present in a similar fashion. Take care, chbare. Link to comment Share on other sites More sharing options...
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