Archive for April2011

Conclusion to "The path (more) traveled" at EMS1.com

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The conclusion to “The path (more) traveled” has been posted. Did you recognize the rhythm as AF/WPW? This is one situation where a CCB could be the last medication a patient receives! Enjoy!

88 year old female CC: Chest pain

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Here’s a really interesting ECG submitted by my good friend David Hildebrandt. EMS is called to an assisted living facility for an 88 year old female who is weak and complaining of chest pain. The patient is found lying on her side in bed. She appears acutely ill and states she is nauseated. She is […]

49 year old male CC: Chest pain – Conclusion

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This is the conclusion to 49 year old male CC: Chest pain. Let's take another look at the 12-lead ECG (the one with lead V4 in the position of right-sided lead V4R). I was wondering if anyone would notice that I've shown this ECG before. It's from my 3-part tutorial on right ventricular infarction. Specifically […]

49 year old male CC: Chest pain

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From the archives. EMS is called to the vacation residence of a 49 year old male complaining of chest pain. On arrival the patient is found sitting at the kitchen table. He appears anxious and acutely ill. Past medical history: Healthy Meds: None Allergies: NKDA Skin is cool, pale and diaphoretic. He confirms that he […]

74 year old female CC: Chest pain – Conclusion

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This is the conclusion to 74 year old female CC: Chest pain. As usual I enjoyed reading the comments! My goal is to get you guys thinking and it’s nice to see you discuss “stable versus unstable”, the need for sedation, and the importance of considering the Hs and Ts! Let’s take another look at […]

74 year old female CC: Chest pain

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Is there anything else you’d like to know about this patient?

50 year old male CC: Chest pain – Discussion

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This is the discussion for 50 year old male CC: Chest pain. You may recall that the patient started experiencing chest pain during sexual intercourse. Many of you were appropriately concerned about the possible use of drugs for erectile dysfunction that would contraindicate nitroglycerin! Thanks for pointing that out. In this case the patient was […]

50 year old male CC: Chest pain

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Here’s a really interesting case submitted by “Anonymous from Ann Arbor, Michigan.” Wolverines! 🙂 Sorry, Buckeyes. EMS is called to the residence of a 59 year old male with a chief complaint of chest pain. Past medical history: Dyslipidemia Meds: Zocor The patient was given 600 mg ASA by the spouse prior to EMS arrival. […]

85 year old female CC: Respiratory distress – Discussion

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This is the follow-up and discussion for 85 year old female CC: Respiratory distress. As usual, thank you for all the insightful comments! The case demonstrates some very important points not the least of which is that the differential diagnosis of shortness of breath can be difficult, even for emergency physicians who have access to […]

85 year old female CC: Respiratory distress

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EMS is called to a local nursing home for a 85 year old female with a chief complaint of respiratory distress. On arrival the patient is found lying in bed in obvious distress. Respirations are 40 and shallow with a prolonged expiratory phase and accessory muscle usage. Auscultation of the chest reveals a poor tidal […]

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