ERDoc Posted August 24, 2008 Share Posted August 24, 2008 You are called to the local precinct for a 22y/o male who is complaining of chest pain. As you arrive at the precinct on officer meets you at the front door and tells you that they have a 22y/o male that they took into custody about an hour ago. They had to wrestle with him a little but not enough that they even broke a sweat. He was fine until about 2 minutes before they called at which point he started c/o chest pains. You enter the cell and find your pt clutching his chest. He tells you, "I'm having some bad pains. Get me to the hospital, bitches." Assume scene safety and all of that other stuff. Let's focus on medical management. What do you want to know? Link to comment Share on other sites More sharing options...
chbare Posted August 24, 2008 Share Posted August 24, 2008 Any drugs on board. Cocaine up the hooha for example? Any past history, medications, or allergies? Vital signs and XII lead? IV access, blood sugar, and a little O2 if it makes him feel better. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted August 24, 2008 Author Share Posted August 24, 2008 Any drugs on board. Cocaine up the hooha for example? Any past history, medications, or allergies? Vital signs and XII lead? IV access, blood sugar, and a little O2 if it makes him feel better. Take care, chbare. We'll work on the history first and come back to the rest later. The pt denies any drugs. He has a h/o ADD but does not take any meds. No allergies. Link to comment Share on other sites More sharing options...
mobey Posted August 24, 2008 Share Posted August 24, 2008 Quality and provocation of pain? Any associated N&V or SOB? How does the Pt. present - obvious distress? Where was the Pt. arrested from? Violent scene? Party? etc... Link to comment Share on other sites More sharing options...
ERDoc Posted August 24, 2008 Author Share Posted August 24, 2008 Quality and provocation of pain? Any associated N&V or SOB? How does the Pt. present - obvious distress? Where was the Pt. arrested from? Violent scene? Party? etc... The pain is sharp, stabbing in the left side of his chest. It is constant and has been getting worse. Nothing seems to make it better or worse. He is nauseous and diaphoretic. He does feel sob. He looks pale and is cool and clammy. He appears very uncomfortable. He was arrested after he tried to run from the police for running a red light. They were able to use the spike-strips to stop him and there was no MVA. He attempted to run on foot and that is when he got into the altercation with the cops. It was 3 on 1 so it was a relatively quick incident. Link to comment Share on other sites More sharing options...
mobey Posted August 24, 2008 Share Posted August 24, 2008 O2 sats? Air entry sounds? Link to comment Share on other sites More sharing options...
ERDoc Posted August 24, 2008 Author Share Posted August 24, 2008 O2 sats? Air entry sounds? Sat 96% on room and and goes to 99% on NRB. Lungs are clear bilat. BP is 160/105 and HR is 124. RR 22 and slightly labored. You get a 12-lead that shows sinus tachy with unifocal PVCs (3-4 per minute). He has 5mm ST elevations in the anterior leads. You have a virtual pharmacy in you ambulance as well as a full diagnostic setup so you can get xrays, CTs, MRI and there is even a tricorder. What do you want to do for this guy? Link to comment Share on other sites More sharing options...
mobey Posted August 24, 2008 Share Posted August 24, 2008 Sat 96% on room and and goes to 99% on NRB. Lungs are clear bilat. BP is 160/105 and HR is 124. RR 22 and slightly labored. You get a 12-lead that shows sinus tachy with unifocal PVCs (3-4 per minute). He has 5mm ST elevations in the anterior leads. You have a virtual pharmacy in you ambulance as well as a full diagnostic setup so you can get xrays, CTs, MRI and there is even a tricorder. What do you want to do for this guy? HAHAHA, alright I'll take this to the length of my knowledge (Canadian BLS) I have not taken 12 leads yet (medic school starts Sept 15) but I believe I am seeing the elevation in lead II,III, and AVF (nope didn't google please correct me if neccisary), I am unsure about the 5mm though, I have no idea what the tolerence is so I will treat as an AMI. IV NaCl 18g, TKO for now. ASA, 325mg Lift to cot, Spray 0.4mg Nitro SL. Link to comment Share on other sites More sharing options...
chbare Posted August 24, 2008 Share Posted August 24, 2008 IV access, a little O2 for good looks and style points, try 0.4mg of NTG SL, and a dose of fentanyl for the pain. Hold on beta blockade at this point. Anterior leads would be: V3 & V4. Any depression in any other leads, axis deviation, BBB, or PRI changes? Pulses in all extremities strong and equal, JVD, blood pressure difference between arms, hoarse voice? Can we get: Port CXR, CBC, CMP, Cardiac isoenymes, coagulation panels, urine tox screen, ethanol, and TSH to start? Take care, chbare. Link to comment Share on other sites More sharing options...
mshow00 Posted August 24, 2008 Share Posted August 24, 2008 I think the bitches comment earns him some silver or green anaestesia just kidding... treat with ACLS/SOGs... take an officer a long for the ride(unless they are just gonna issue a warrant for his arrest later)... beat feet to the ER Link to comment Share on other sites More sharing options...
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