Arizonaffcep Posted December 3, 2008 Author Share Posted December 3, 2008 No known HX of a hernia. Link to comment Share on other sites More sharing options...
defib_wizard Posted December 3, 2008 Share Posted December 3, 2008 arizonaffcep - if I get to go to flying here in town on this call ( again) I'm gonna hurt ya! LOL But seriously; Lets get him out of the restaurant start him on O2, and do a 12 lead ecg. Does he have = radial and pedal pulses? Any pulsating masses? How does he describe the pain? Sharp and/or tearing in his cx and Im thinking PE vs Thoracic Aortic Aneurysm. Heavy and dull possible MI. Now for questions 1 Did the pain change with O2 2 Did the 12 lead show evidence of STEMI? 3.Any other changes with tx and does he have any allergies? As with any call like this an IV is indicated of NaCl 0.9% at TKO. Link to comment Share on other sites More sharing options...
pacman Posted December 3, 2008 Share Posted December 3, 2008 Since he is a diabetic, what's his finger stick? Is this guy dying of thirst? Tried PE route - shot down Tried GI route - shot down Still can be NSTEMI. Perhaps hyperglycemic episode leading towards DKA with recurrent chest pain? Has NTG and O2 helped at all?? Probably give the ASA and the betablocker to cover bases as well. So, for the record, whats that finger stick? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 3, 2008 Share Posted December 3, 2008 With what has been presented, I would rule out in this order: 1. MI or AAA 2. Left sided Heart Failure 3. PE (already semi-ruled out) 4. Spontaneous Pneumo (maybe 10-15% at this point, so still satting well) 5. Pleurisy / Pneumonia / Lung CA or GI event Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 3, 2008 Author Share Posted December 3, 2008 arizonaffcep - if I get to go to flying here in town on this call ( again) I'm gonna hurt ya! LOL But seriously; Lets get him out of the restaurant start him on O2, and do a 12 lead ecg. Does he have = radial and pedal pulses? Any pulsating masses? How does he describe the pain? Sharp and/or tearing in his cx and Im thinking PE vs Thoracic Aortic Aneurysm. Heavy and dull possible MI. O2 is applied at 15lpm and 12 lead done...no SETMI noted. Radial pulses +, neg pedal pulses. No pulsating masses noted. Pain is described as "It really hurts! Do something!" Now for questions 1 Did the pain change with O2 2 Did the 12 lead show evidence of STEMI? 3.Any other changes with tx and does he have any allergies? As with any call like this an IV is indicated of NaCl 0.9% at TKO. Pain did not change with O2. No STEMI noted. Only change is in vitals- B/P-210/140 Pulse-115 RR-20 Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 3, 2008 Author Share Posted December 3, 2008 Since he is a diabetic, what's his finger stick? Is this guy dying of thirst? Tried PE route - shot down Tried GI route - shot down Still can be NSTEMI. Perhaps hyperglycemic episode leading towards DKA with recurrent chest pain? Has NTG and O2 helped at all?? Probably give the ASA and the betablocker to cover bases as well. So, for the record, whats that finger stick? FSBS-113 325mg ASA given PO-no change. What kind of and how much of a betablocker do you want? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 3, 2008 Share Posted December 3, 2008 Aeortic Aneurysm (higher up) or left sided heart failure Link to comment Share on other sites More sharing options...
defib_wizard Posted December 3, 2008 Share Posted December 3, 2008 I'm in az also so no beta blocker in my drug box. I would like to start giving the pt morphine. I can give up to 14 mg under standing orders. Since this pain is not appearing as cardiac. and absent pedal pulses. I'm leaning towards a TAA. Patching for MD input would be a good idea. I would hold off on the ntg until I talked to a dr. Does morphine help him? Link to comment Share on other sites More sharing options...
ERDoc Posted December 3, 2008 Share Posted December 3, 2008 Onset of pain? Was it sudden? Does it radiate? Describe the pain. Any associated symptoms (nausea, vomitting, diaphoresis, shortness of breath)? Does anything make it better or worse? Has he ever had a similar pain? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 4, 2008 Share Posted December 4, 2008 missed the no pedal pulses -- definitely aneurysm -- probably in the arch or posterior abdominal aneurysm. Link to comment Share on other sites More sharing options...
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