Just Plain Ruff Posted July 13, 2011 Share Posted July 13, 2011 Exam shows no reddened or inflammed areas. She has not and any type of pain recently except the shortness of breath. She says she sits for about an hour but gets up and does other stuff,. so no, not long enough to cause clots to form. and family history is unavailable. Well actually clots form over a period of time. Depending on her level of high cholesterol and her diet they can form over periods of months. My close friend many years ago had a huge clot in his left calf that they had to go in and put some type of clot busting drug directly on it which of course didn't work so they went in and stripped his vein in his calf. He said it hurt like a bitch having that happen. So she doesn't have a clot, what else could it be? You said chest pain, what is it's strength, is it off and on or is it constant? Is it tearing or just constant? We could have a musculoskeletal event that was triggered by her getting up and turning wrong. Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 13, 2011 Author Share Posted July 13, 2011 Well actually clots form over a period of time. Depending on her level of high cholesterol and her diet they can form over periods of months. My close friend many years ago had a huge clot in his left calf that they had to go in and put some type of clot busting drug directly on it which of course didn't work so they went in and stripped his vein in his calf. He said it hurt like a bitch having that happen. So she doesn't have a clot, what else could it be? You said chest pain, what is it's strength, is it off and on or is it constant? Is it tearing or just constant? We could have a musculoskeletal event that was triggered by her getting up and turning wrong. She states that it is hard to describe. She said its constant and it isnt musculoskeletal. It cannot be reproduced by palpation. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 13, 2011 Share Posted July 13, 2011 She states that it is hard to describe. She said its constant and it isnt musculoskeletal. It cannot be reproduced by palpation. I didn't see the mitral valve replacement in the history. Could the valve have malfunctioned or thrown it's own clot? It might just be me and my recollection but shouldn't she be on a blood thinner based on the heart valve replacement? My thought might be that the valve developed plaque on it/or an issue on it and it finally broke off going to her lung. Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 13, 2011 Author Share Posted July 13, 2011 I didn't see the mitral valve replacement in the history. Could the valve have malfunctioned or thrown it's own clot? It might just be me and my recollection but shouldn't she be on a blood thinner based on the heart valve replacement? My thought might be that the valve developed plaque on it/or an issue on it and it finally broke off going to her lung. I think she might have been on a ASA regimine actually. Sorry about the red herring, I am having to run this based soley off recollection. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 13, 2011 Share Posted July 13, 2011 Regardless I'd give her 324 ASA now. Until we know the etiology I'm going to assume cardiac in origin though I believe that it does sound like a possible P/E or bronchospasm. The twelve lead certainly can't be trusted to have ruled out a cardiopathy in this patient. Do you have ETCO2? What does it show? Dwayne Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 13, 2011 Share Posted July 13, 2011 Regardless I'd give her 324 ASA now. Until we know the etiology I'm going to assume cardiac in origin though I believe that it does sound like a possible P/E or bronchospasm. The twelve lead certainly can't be trusted to have ruled out a cardiopathy in this patient. Do you have ETCO2? What does it show? Dwayne So Dwayne, what might the bronchospam be caused by? Doesn't sound like she encountered an allergen in her home since she's been in the house for better part of the day? I know that you can not be allergice to a stimulus one time yet the next time you come into contact with that same stimulus you are allergic. (reminds me of a physiology experiment that I saw in paramedic school). I'm really leaning towards the PE over anything else but I'm open to the 'Bronchospasm' theory also. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 13, 2011 Share Posted July 13, 2011 Not sure man, but I used to get them that appeared spontaneous. What is her BGL? DDX at this time for me in order of index of suspicion. MI PE Bronchospasm Anxiety secondary to argument with husband. At this point she's relatively stable. But what would be your treatment options if you were remote and help was at least a few hours away? I wonder if it would make sense to trial Glucagon?...But I think some of these questions would likely be answered by SPO2. Dwayne Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 14, 2011 Author Share Posted July 14, 2011 Not sure man, but I used to get them that appeared spontaneous. What is her BGL? DDX at this time for me in order of index of suspicion. MI PE Bronchospasm Anxiety secondary to argument with husband. At this point she's relatively stable. But what would be your treatment options if you were remote and help was at least a few hours away? I wonder if it would make sense to trial Glucagon?...But I think some of these questions would likely be answered by SPO2. Dwayne Her BGL is 120. We do not have a ETCO2 at this time. She was not arguing with the husband and stated by her and her husband they were just watching TV and eating breakfast. Patient does not look scared or nervous. Upon impression and inspection you find no evidence of physical abuse or psychological/mental abuse. You are about 10 minutes outside of the nearest hospital. Why would you want ot trial glucagon for a patient having SOB? You have given 324mg ASA. She states that her SOB is slightly reduced with the application of oxygen. What other treatments would you like. Are you ready to start hitting the road? Link to comment Share on other sites More sharing options...
Bieber Posted July 14, 2011 Share Posted July 14, 2011 (edited) Her BGL is 120. We do not have a ETCO2 at this time. She was not arguing with the husband and stated by her and her husband they were just watching TV and eating breakfast. Patient does not look scared or nervous. Upon impression and inspection you find no evidence of physical abuse or psychological/mental abuse. You are about 10 minutes outside of the nearest hospital. Why would you want ot trial glucagon for a patient having SOB? You have given 324mg ASA. She states that her SOB is slightly reduced with the application of oxygen. What other treatments would you like. Are you ready to start hitting the road? Glucagon's a smooth muscle relaxant, though I think I'd probably try a couple other things before I went to it, considering it'll have beta agonist effects as well and in a patient complaining of chest pain. I agree with Dwayne on the ASA, and why don't we pop a nitro and see if that does anything? You said her lungs were clear, right? I'm gonna go down the cardiac route, get my line if I don't have it already, NS TKO, and do serial 12-leads at this point. I'm concerned right now that this could either be an atypical MI or possibly a PE. Let's reassess! Edited July 14, 2011 by Bieber Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 14, 2011 Author Share Posted July 14, 2011 Glucagon's a smooth muscle relaxant, though I think I'd probably try a couple other things before I went to it, considering it'll have beta agonist effects as well and in a patient complaining of chest pain. I agree with Dwayne on the ASA, and why don't we pop a nitro and see if that does anything? You said her lungs were clear, right? I'm gonna go down the cardiac route, get my line if I don't have it already, NS TKO, and do serial 12-leads at this point. I'm concerned right now that this could either be an atypical MI or possibly a PE. Let's reassess! I didn't know that, interesting. You have administered the nitro. Yes the lung sounds were clear and remain clear. You have a line in place. Her BP is now 124/86 HR- 120 RR 24 still labored SpO2- 98 serial 12 leads still show no ectopy. I like your DDx. Are you en route to the hospital yet? Link to comment Share on other sites More sharing options...
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