Not another chest pain...

[ERDoc]

You are called to a private residence where there appears to be a party going on. Your pt is a 32y/o male with no PMH who is complaining of sudden onset of left side chest pain that started while he was talking to some friends at the party. (VS-eh, should we let this one walk? )

[chbare]

ERDoc, LOC?, V/S?, supplemental O2, and cardiac monitor with a 12 lead if possible. Any history of drug use or ingestion of OTC meds/herbal supplements? Can he describe the pain? Lung sounds? Associated S/S? (N/V, Abd pain, dyspnea)

Take care,

chabre.

[ERDoc]

No LOC. VS 210/106 118 22 Pt takes no legal drugs, but says he has taken a few speedballs and has been drinking some Crazy Horse. No herbal suplements. The pain is crushing and he is diaphoretic and nauseous. No sob. LS CTA b/l.

[AZCEP]

O2/IV/12 lead

No legal drugs. How about illegal?

NTG/ASA

[ptemt]

Possible pulmonary embolus from not cleaning his junk properly?

http://en.wikipedia.org/wiki/Speedball_(drug)

"...........A variation of the speedball, known colloquially as Mad Max Beyond Thunderdome, has recently come into vogue in circles of drug users across the Northeast of the United States and in parts of Canada. Requiring a larger syringe than is common, MMBT requires the addition of a shot of the powerful liquor Everclear as well as an increased amount of both heroin and cocaine. The presence of the potent alcohol apparently enhances the euphoric effects of the already volatile combination. It is unclear as to what, if any, connection this particular cocktail has to the Mel Gibson film of the same name."

[Arachne]

As BLS, I'd be calling ALS to intercept due to the high blood pressure and general appearance, especially if further assessment can't rule out cardiac origin of the chest pain. Because of the limited assessment and treatment available to BLS, I wouldn't want to mess around onscene.

Recent trauma? Tender on palpation? Is the pain seem more like chest-wall pain or is it deeper? Localized or generalized pain?

Do any bystanders say that he's taken something that he's not admitting to?

[vs-eh?]

Sympathetic toxidrome which will eventually lead into an opioid toxidrome (once the cocaine/amphetamine half of the speedball wears off). The opioid toxidrome may be synergized with the concurrent alcohol ingestion.

Probably should ask him when he took the drugs, and his pattern of use.

So ya, treat accordingly. Get your airway roll out and be prepared for the decreased LOC and respiratory depression/apnea that would normally be seen with an opioid OD.

Tell patient to walk to ambulance/hospital and/or use that horse that I brought up in that last scenario.

[Michael]

while he was talking to some friends at the party.

What were they talking about and might it have upset him?

[JPINFV]

As BLS, I'd be calling ALS to intercept due to the high blood pressure and general appearance, especially if further assessment can't rule out cardiac origin of the chest pain. Because of the limited assessment and treatment available to BLS, I wouldn't want to mess around onscene.

Yea, but thats the answer to just about every scenario. I got sick of posting that after the first time I posted.

(VS-eh, should we let this one walk? )

ABC

Ambulate before carry...

Does he normally use drugs at this location/enviroment? Has he ever had this combination before?

[we just covered addiction and tolerance in my neuro class...]

As with everyone else, a 12 lead would be nice.

Best bet pre-hospital would high-flow O2, rapid transport. Be prepared to control airway and give Narcan (titrated to effect) for when the cocaine wears off.

If it is an MI, give some nitro. Morphine should not be administered.

[chbare]

I agree with everybody that a 12 lead is in order. We need to quickly find out if he is having myocardial ischemia or injury. I suspect he is. I have seen a few young healthy people have MI's from cocaine use. His pressure is elevated and I agree with nitro and ASA if no contraindications exist. I also will consider beta blockers especially if nitrates do not help with the elevated pressure. Any other pertinent past history or allergies?

Take care,

chbare.