Here is a great case from NYC Medic, hopefully you'll enjoy it as much as we did!
It's a hot summer's night in the city when the tones drop to Assist Police reference a 10-34 (assault in progress) at a large apartment complex. You arrive and find two cruisers parked, with no officers in sight. A quick check with dispatch reveals they're on the 11th floor in room 1108.
A sign on the elevator politely informs you that it has seen better days and you'll need to use the stairs.
As you exit the stairwell onto the floor you have a good idea as to the location of the scene. Shouting is audible down the hall where an officer stands outside the doorway with his arms across his chest. He motions you inside, letting you know, "they don't speak English, we think it's Russian."
An officer inside gives you a quick report, "we think he wants her to go to the hospital, but she does not want to. We haven't been able to get them to calm down."
Inside you see a large man yelling at the officer and his wife, gesticulating wildly. The wife is seated in a chair and is yelling back, their conversation unintelligible. After exchanging glances with your partner, you yell the only Russian you know, "ROSE-DEST-VOM KHRIS-TO-VIM!" (Merry Christmas!)
The couple stops, turns to you and begins laughing. You introduce yourself and walk towards the wife, who upon closer inspection is clutching her chest. You point to her chest and ask her if it hurts; she nods her head.
Your partner spies a bag of medications on a counter and begins going through it. You place your hand on her wrist to get a pulse while he reads off the medications: "Lasix, digoxin, simvastatin, some vitamins, and coumadin."
One of the officers places her on the monitor while you get a blood pressure.
- Skin: cool, dry
- HR: 40, regular and weak
- BP: 142/64
- RR: 20, unlabored
- SaO2: 92% on room air
The first 3-Lead print is handed to you:
Your partner ask one of the officers to go get the stair chair from your unit.
A 12-Lead is acquired:
- Rate: 39
- RR: 1538 ms
- PR: *
- QRSd: 160 ms
- QT: 571 ms
- QTc: 460 ms
- P/QRS/T Axis: * / -82 / 91
What do you think is going on?
Given the patient's medications, what medical history do you think she has?
What treatments should the patient receive and should they be started in the apartment or enroute?