chbare Posted July 15, 2006 Share Posted July 15, 2006 You are called to the Denver airport (DIA) for a 24 year old male complaining of chest pain. What would you like to know? Take care, chbare. Link to comment Share on other sites More sharing options...
future medic 48_234 Posted July 15, 2006 Share Posted July 15, 2006 I would like Vitals, SAMPLE and OPQRST. Link to comment Share on other sites More sharing options...
chbare Posted July 15, 2006 Author Share Posted July 15, 2006 Future medic 48_234, V/S- P-118 RR-22 with dyspnea B/P 140/88 Pulse Ox-90% R/A Temp-98.8 F S- Subjective- states, "I am having chest pain, pain in my elbows, I am having a hard time breathing and I feel dizzy." Objective- External physical exam is unremarkable, diminished lung sounds noted, frequent NPC noted A-NKDA M-None PMHX-None L-Prior to boarding the plane about 8 hours ago E-Started suddenly while on the plane O-A few hours ago while on the plane P-Not really sure Q-Lots of chest pressure sub sternal and deep aching of the elbows that does not increase with movement R-None S-10/10 T-A few hours ago You will need to ask more specific questions if you want more in depth answers. This is anotyher one of those history will tell all scenarios. Take care, chbare. Link to comment Share on other sites More sharing options...
JackMaga Posted July 15, 2006 Share Posted July 15, 2006 Where is he coming from? ANd about those diminished lung sounds: are they diminished bilaterally? Do I hear anything other the normal MV (like crackles, wheezes)? What about heart sounds? Is there JVD? Link to comment Share on other sites More sharing options...
chbare Posted July 15, 2006 Author Share Posted July 15, 2006 JackMaga, he was on vacation in Hawaii. No adventitious lung sounds noted and breath sounds are diminished bilaterally. ( Hard to tell, but this may be because he states it is hard to breath and his breaths are shallow) No abnormal heart tones noted. No JVD noted. Take care, chbare. Link to comment Share on other sites More sharing options...
JackMaga Posted July 15, 2006 Share Posted July 15, 2006 Ok so how about we talk a bit about his holiday? I'm particularly interested to know if he did scuba diving, or something like that... Also if he had any other phisical problem during the holiday, even mundane things, like a one-day fever, general malaise, he got stung by a fish... Also, what ethnicity is he? BTW as I'm inquiring about his private life, I hope my partners are giving him O2 (i'd stick to a nasal cannula right know), establishing an IV (TKO rate) and performing a 12 lead ECG. Link to comment Share on other sites More sharing options...
medic001918 Posted July 15, 2006 Share Posted July 15, 2006 Ok so how about we talk a bit about his holiday? I'm particularly interested to know if he did scuba diving, or something like that... Also if he had any other phisical problem during the holiday, even mundane things, like a one-day fever, general malaise, he got stung by a fish... Also, what ethnicity is he? BTW as I'm inquiring about his private life, I hope my partners are giving him O2 (i'd stick to a nasal cannula right know), establishing an IV (TKO rate) and performing a 12 lead ECG. +1 on the risk of diving injury. You're not supposed to fly for 24 hours after diving due to the build up of gases in the body. The sudden change in pressure with going to different elevations is enough to bring on a case of the bends, or decompression sickness. So please, tell us more about his vacation... Shane NREMT-P Link to comment Share on other sites More sharing options...
future medic 48_234 Posted July 15, 2006 Share Posted July 15, 2006 What was the patient doing the day before? Is there any heart desease that runs in the family? What is NKDA? Over excertion of muscle movement? Link to comment Share on other sites More sharing options...
MedicDude Posted July 15, 2006 Share Posted July 15, 2006 I'm with JackMaga-- I'd ask if he did any SCUBA or "free" diving while in Hawaii, and also take a gander at his legs (assess for swelling, tenderness) to rule out a possible DVT. Also, I'm curious if he's a tall, skinny guy... (prone to spontaneous pneumo) Link to comment Share on other sites More sharing options...
AZCEP Posted July 15, 2006 Share Posted July 15, 2006 Good pick up on the diving issues. I'm going to spin this another way and suspect an embolus. ECG, D-dimer(we are still in our cool guy ambulance, right?), CT of the chest. Any difference in the pulse side-to-side? Upper and lower extremities? Link to comment Share on other sites More sharing options...
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