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Patient chest pain

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You are working in a rural EMS system you are on a three man truck which is made up of two EMT-Bs and yourself (Medic, B, what have you). You are dispatched to a patient having chest pain. You arrive at the house to find a professionally cleaned house with nothing noted on the outside. Scene is to be considered safe until further notice. Two people meet you at the door stating that they are the parents of a 20 year old male patient who is inside having chest pain and shortness of breath, not acting right.

Go.

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ok scenne safe

lets start PQRST?

Vitals?

O2 therapy

ECG....any abnormailities?

with this information we can go on and determine course of action

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Where in the house is he?

Anything around to suggest what might be causing his problem e.g. gas left on, empty pill bottles, meth pipes?

General physical state?

How grossly unwell does he look?

Observations?

Any signs or symptoms of chronic or acute cardiorespiratory disease or dysfunction?

I wouldn't put him on O2 unless his SPO2 is < 98%; oxygen is not a "general" treatment nor it is a treatment for tachypnea

Edited by Kiwiology

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question mark was left of the o2 line kiwi

however it is chest pain, with out any know cause as yet so it is not a 'general treatment' as yet

and we do not have any vitals as yet so how do we know if the pt has any tachypnea? he has SOB. I can be SOB and breathing at 12 - 16 resps/ min

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I wasn't getting a dig at you mate, but it is my absolute damn near #1 pet hate when people slap somebody on oxygen "just because" without any consideration if they need it or not. There is good evidence that supra physiologic amounts of oxygen make outcomes worse for MI and stroke patients.

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I'm hearing CP and SOB, I'm thinking oxygen as a POSSIBLE treatment. It's what's indicated in protocol. It may not be indicated when I actually get eyes on the patient. We'll see. But if it's not high up in my brain, I'm doin' it wrong...

Waiting for more patient info at this point.

Wendy

CO EMT-B

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ABC's PQRST, medical history, How is he positioned, sitting up, tripod position, laying down supine, on side. Skin, dry, wet, cold warm, cap refill? When did this start, what were pt's activities prior to onset of chest pain and sob. My protocols say sob gets o2 non rebreather.

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What Craig said plus SAMPLE.I'm especially interested in medications, prescription, OTC, or illicit.

I wouldn't put him on O2 unless his SPO2 is < 98%; oxygen is not a "general" treatment nor it is a treatment for tachypnea

Around here we treat the patient, not the machine. In my books (and not my protocol book) any SOB is an indication for O2 therapy with a NC at least, the pulse oximeter could be getting an erroneous reading.

Edited by Arctickat

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ok scenne safe

lets start PQRST?

Vitals?

O2 therapy

ECG....any abnormailities?

with this information we can go on and determine course of action

Where in the house is he?

Anything around to suggest what might be causing his problem e.g. gas left on, empty pill bottles, meth pipes?

General physical state?

How grossly unwell does he look?

Observations?

Any signs or symptoms of chronic or acute cardiorespiratory disease or dysfunction?

I wouldn't put him on O2 unless his SPO2 is < 98%; oxygen is not a "general" treatment nor it is a treatment for tachypnea

question mark was left of the o2 line kiwi

however it is chest pain, with out any know cause as yet so it is not a 'general treatment' as yet

and we do not have any vitals as yet so how do we know if the pt has any tachypnea? he has SOB. I can be SOB and breathing at 12 - 16 resps/ min

I wasn't getting a dig at you mate, but it is my absolute damn near #1 pet hate when people slap somebody on oxygen "just because" without any consideration if they need it or not. There is good evidence that supra physiologic amounts of oxygen make outcomes worse for MI and stroke patients.

I'm hearing CP and SOB, I'm thinking oxygen as a POSSIBLE treatment. It's what's indicated in protocol. It may not be indicated when I actually get eyes on the patient. We'll see. But if it's not high up in my brain, I'm doin' it wrong...

Waiting for more patient info at this point.

Wendy

CO EMT-B

ABC's PQRST, medical history, How is he positioned, sitting up, tripod position, laying down supine, on side. Skin, dry, wet, cold warm, cap refill? When did this start, what were pt's activities prior to onset of chest pain and sob. My protocols say sob gets o2 non rebreather.

What Craig said plus SAMPLE.I'm especially interested in medications, prescription, OTC, or illicit.

Around here we treat the patient, not the machine. In my books (and not my protocol book) any SOB is an indication for O2 therapy with a NC at least, the pulse oximeter could be getting an erroneous reading.

Lets get a closer look at the scene.

You enter the residence and you see nothing out of the ordinary. They do not use gas in their house. You find a 20 year old male patient pacing around the room in only his undergarments. He is red and sweating profusely. He states that he just can't seem to cool down. You also note that it is around 65 degrees in the house and it is around 75 degrees outside. Your patient is awake, alert, and oriented to person, place, time, and event. Your vitals are:

BP- 200/90

Pulse-160

RR-24

LS-Clear

Pulse Ox-98

BGL-112.

Medical History- URI earlier this week being treated by PCP with amoxicillin.

Allergies- NKDA No food allergies

Pain- located somewhat in chest but is only a 2/10.

Skin- Red, hot, diaphoretic

Nothing else remarkable.

Plays baseball religiously and does not use drugs because the team would kick him off for using.

Continue assessment.

Whats next for this guy?

DDx?

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