fireflymedic Posted September 7, 2008 Share Posted September 7, 2008 You are called out to a 41 year old male for chief complaint of hiccups. On arrival, the man informs you that he has had intractable hiccups for the last four hours and can't get them to stop. He also says his chest hurts rating the pain a 5 out of 10 with inspiration. You take vitals and this is what you get : pupils : PEARL BP : 88/62 pulse : 108, thready resp : 22, shallow Meds : plavix, claritin, daily asprin 81 mg, nitro Allergies : NKDA PMHX : angina Guy is a frequent business traveler and states he just got back from a trip today with the problems starting on his way home. Says he took 2 nitro bringing pain down from 7 to 5, but still experiencing pain. what do you think is this guy's problem and what else would you like to know? Link to comment Share on other sites More sharing options...
emt322632 Posted September 7, 2008 Share Posted September 7, 2008 What happened before the hiccups started? What did he have to eat? Any ABD pain, distention? Any allergies? Trouble breathing? Does the pain radiate or stay in one place, what does it feel like? Fever? Chills? Did he recently start taking any of the medications? Any over the counter or herbal medications? Can we get a temp? 12 Lead EKG, Lung Sounds, SpO2...IV started as well in preperation for possible fluid bolus... differentials...poss MI, pneumonia, bleed somewhere... Link to comment Share on other sites More sharing options...
spenac Posted September 7, 2008 Share Posted September 7, 2008 Pulmonary Embolism? Link to comment Share on other sites More sharing options...
fireflymedic Posted September 8, 2008 Author Share Posted September 8, 2008 well just go ahead and ruin the party ! PE it is Link to comment Share on other sites More sharing options...
reaper Posted September 8, 2008 Share Posted September 8, 2008 You are called out to a 41 year old male for chief complaint of hiccups. On arrival, the man informs you that he has had intractable hiccups for the last four hours and can't get them to stop. He also says his chest hurts rating the pain a 5 out of 10 with inspiration. You take vitals and this is what you get : pupils : PEARL BP : 88/62 pulse : 108, thready resp : 22, shallow Meds : plavix, claritin, daily asprin 81 mg, nitro Allergies : NKDA PMHX : angina Guy is a frequent business traveler and states he just got back from a trip today with the problems starting on his way home. Says he took 2 nitro bringing pain down from 7 to 5, but still experiencing pain. what do you think is this guy's problem and what else would you like to know? Leave that out next time, It's a big hint. Make people ask if he travels a lot! Link to comment Share on other sites More sharing options...
emt322632 Posted September 8, 2008 Share Posted September 8, 2008 Interesting presentation...hiccups totally took me by surprise...though I got to thinking afterward about the anticoagulant and ASA use, then the business travel... Link to comment Share on other sites More sharing options...
fireflymedic Posted September 9, 2008 Author Share Posted September 9, 2008 hey I was trying to give one that even newer basics could play along ! I CAN be nice sometimes ! Not all my patients are weird ones ! Link to comment Share on other sites More sharing options...
CBEMT Posted September 9, 2008 Share Posted September 9, 2008 If he's got a pacemaker, one of the leads has broken loose, perfed the diaphragm, and is now pacing it, causing the hiccups. True story from one of the pacemaker dudes at my trauma center during a CE class. Link to comment Share on other sites More sharing options...
firedoc5 Posted September 13, 2008 Share Posted September 13, 2008 I know PE is the culprit. Other wise 100mg Thorazine IM may have done wonders. At least it helpd me one time, even though it was only temporary. Link to comment Share on other sites More sharing options...
okmedic Posted November 27, 2008 Share Posted November 27, 2008 If he's got a pacemaker, one of the leads has broken loose, perfed the diaphragm, and is now pacing it, causing the hiccups. I actually lol'ed after reading that!! Link to comment Share on other sites More sharing options...
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