Many thanks to an anonymous reader who submitted this great case! As always, some details have been changed to protect provider and patient privacy.
You're dispatched to the parking garage of a busy shopping mall for a 56 year old female whom a 3rd party caller relates is, "short of breath".
Upon your arrival you find an engine crew out with the patient, who is seated on the running board under the pump panel on their engine. The firefighters have placed her on a nasal cannula and are attempting to talk with her through a bystander.
The captain on the engine relays that she doesn't speak much English, but what they gather is that she was walking back to her car and became short of breath and dizzy. The patient states she felt better sitting and on oxygen.
Your partner relays the first set of vitals:
- Pulse: 130, regular
- BP: 132/80
- RR: 28
- SpO2: 89% on r/a, increasing to 94% @ 4 L/min by NC
- Lungs: clear and equal bilaterally
The bystander helps translate her history:
- Allergies: None
- Medications: None
- PMHx: None
- Last ins/outs: Some urinary incontinence handled through PO restriction
- Events: Walking to her car, became short of breath and dizzy, denies loss of consciousness, she is visiting from another country and was on a "long flight" last week
You ask if the patient would like to go to the hospital and she nods her head. When the crew stands her up to help her to your stretcher, she becomes dizzy and clutches her chest. Once on the stretcher your partner places her in trendelenburg as you move her to the unit.
Inside, your partner places her on the monitor while you complete a physical assessment. Her skin color appears fine, but you notice some pedal edema. Old scars are present on her knees which the patient states was from surgery. She denies pain to palpation of her chest wall and her lung sounds remain clear bilaterally. Her physical exam appears largely unremarkable.
Her radial pulse is a bit weaker and has slowed to 120 bpm. She remains tachypneic, but denies chest pain once she was laid down. Her SpO2 has increased to 97% on 4 L/min and her respiratory rate has decreased slightly.
As you start an IV, your partner acquires a 12-Lead.
Your partner asks if you need anything else before you head enroute to the hospital.
- What is the patient's rhythm? What does the patient's 12-Lead show?
- Does this patient require any interventions before going to the hospital?
- What type of hospital does this patient need?
- What do you think is wrong with this patient?