scope2776 Posted May 15, 2007 Share Posted May 15, 2007 You are dispatched to 28 y/o M DIB at 0100. No further information from dispatch. You respond to reasonably priced and affordable condominiums recently built by a large contractor. The scene is safe. Weather is slightly overcast with sporadic showers. A well built 28 y/o M greats you at the door. Your general impression is a young adult male who appears to be in a little respiratory distress. Your EMT partner gets you a set of vitals: P: 90 and regular, R: 26 and labored, BP: 108/90, RA SpO2: 90%. The pt states he has had increasing DIB since he tried to go to bed at about 2300. Since he has gotten up and called 911, the pain seems to have gotten better. He also reports "stabbing" chest pain 4/10 that comes and goes, but has also gotten better in the few minutes before you have arrived. The patient believes the CP started after lunch as a result of the new "hotter than hell" boneless wings at the local bar. Thinking he was suffering from heartburn the pt eat a light dinner; a chef salad. Even still the CP increased throughout the evening and now he has difficulty catching his breath. Throughout this history the patient has to take breaks to breath, before continuing to speak. No PMx and NKDA. Besides the Zantac he took after lunch the patient has taken no medications. Continue the assessment and treatment from here! Link to comment Share on other sites More sharing options...
Bombera Posted May 15, 2007 Share Posted May 15, 2007 What about this guy's skin? Color? Moisture? Temp.? Does anything make his chest pain or his DIB better or worse? Does the feeling radiate anywhere else? I'm not a paramedic yet, but I would want to put this guy on a 12 lead because he is presenting with atypical signs of an MI. I would also like to know if this guy is a smoker. Has he experienced this kind of thing before? If so, what was the dx? Is he overwieght? Is he coughing at all? If so, it is a productive cough? What color is the sputum? What about lung sounds? Does the pt have JVD? How about edema? That should help narrow things down. Take care, Bombera Link to comment Share on other sites More sharing options...
speedygodzilla Posted May 15, 2007 Share Posted May 15, 2007 Immediately starting with some treatment I would put the fellow on 6lpm of o2 by nasal. I am guessing that DIB is the same as SOA or SOB. Not one I have heard b4. Past history? Asthma? Ever had a heart attack? 12 Lead is a good idea. Since the pain comes and goes I doubt is is a heart attack but I know little about diagnosing. What is the patients change in vitals after 5 minutes of o2? Thanks Nate EMT-B Link to comment Share on other sites More sharing options...
spenac Posted May 15, 2007 Share Posted May 15, 2007 "reasonably priced and affordable condominiums" cool where and how much? Sorry got distracted. I agree with speedygodzilla and Bombera but would also like blood glucose level. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 15, 2007 Share Posted May 15, 2007 I suspect the following 1. hiatal hernia 2. GERD Both due to the fact that he took a zantac after lunch and he's starting to feel better as well as the history of this starting after he ate those toxic wings. I have a hiatal hernia and GERD and I get these symptoms all the time. A zantac clears em right up. Link to comment Share on other sites More sharing options...
Dustdevil Posted May 15, 2007 Share Posted May 15, 2007 I am guessing that DIB is the same as SOA or SOB. Not one I have heard b4. Whatever it is, he sure likes it. He's used it in both scenarios. I'm not so sure that DIB is synonymous with SOA (whatever that is) or SOB though. In this scenario, he says... The pt states he has had increasing DIB since he tried to go to bed at about 2300. Since he has gotten up and called 911, the pain seems to have gotten better. This leads me to be that DIB has something to do with the pain, since the pain was not mentioned previously in the scenario. Either way, it is keeping me from getting into either scenario when I can't get past the first symptom. :? BTW, Speedy, I never heard of "b4" before either. 8) Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 15, 2007 Share Posted May 15, 2007 well dust, wouldn't DIB on your terms be dead in bed but he seems to have gotten better so maybe DIB dead in bed isn't correct. For the scenario posters out there. please don't use abbreviations. It's the same argument for 10-codes too. Your abbreviations may not be the same as others have. If you are going to post abbreviations please put their definitions out there in parenthesis or somewhere in the scenario. I assumed it was Difficulty in Breathing but your scenario doesn't mention DIB until the EMS people get there. Link to comment Share on other sites More sharing options...
scope2776 Posted May 15, 2007 Author Share Posted May 15, 2007 My apologies about the use of DIB or "Difficulty in Breathing". It's fairly commonly used here and I thought it was a universal thing, again sorry of any confusion. Your EMT partner places the young man on 4 LPM NC and sits him down on a large armchair as you continue the physical assessment. His skin is slightly warm to the touch. He states he has been slightly warm since yesterday, but didn't think anything about it until you asked. Other than that skin is unremarkable. You ask him if anything makes his chest pain better or worse, to which he replies, " it was really painful and hard to breath while I was lying in bed, then I decided to get up and go to the phone, after I called the pain seemed to be going away, and it was easier to breath." You ask him how the CP is now, to which he replies "better than before". You ask him if he has pain anywhere else, he states "no". You ask him if he has any heart, lung or kidney problems, he says "no". No recent surgeries or hospitalizations, excepting a brief visit for a broken rib 3 years ago. His father has had controlled hypertension for 5 years. He is not a smoker and lives alone. He is a software engineer. He is fit and works out at "World Gym" three times a week in addition to pick up basketball games with coworkers on weekends. His basketball team is doing quite well. He is not coughing. Your EMT listens to his lungs and reports they sound "clear". Physical exam revels no signs of edema, JVD or DCAP-BTLS. EMT reports blood sugar is 90. VS after 5 min are as follows: P: 94, R: 26 and labored, BP: 100/92 and SpO2: fluctuates between 89 and 90%. You place him on the monitor and see ST elevation in lead II and III. You decide to do a 12 Lead: Treatments? Transport? Working Dx? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 15, 2007 Share Posted May 15, 2007 The dude's having an MI elevation in leads II, III and AVF atypical MI Presentation. Take him to the hospital following your MI Protocol. ASA, Morphine, IV, oxygen, prep for thrombolytics or whatever else you want to do. Draw some initial labs if you have the equipment to do that and if you have the blood tubes. There has to be some reason he's having an MI, any cocaine abuse history? family history or is it just luck of the draw he got a crappy ticker. Link to comment Share on other sites More sharing options...
spenac Posted May 15, 2007 Share Posted May 15, 2007 Dehydration? Active, warm since yesterday, probably alchole with the hot wings, elevated T( hyperkalemia ). Link to comment Share on other sites More sharing options...
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