The following is a great case from Mordy E, and as always some details have been changed to protect patient privacy.
You and your partner are refueling your ambulance at a gas station when a woman walks up and asks if you could, "come check out my husband."
As you walk over to their car she states that, "he's had chest pain for almost 5 hours now and didn't want me to call 911."
Your patient is standing, pumping gasoline, and appears unwell and diaphoretic. He seems reluctant to accept care at first, but you encourage him to let you check him out and he admits to chest discomfort.
He sits down in the passenger seat and lets you evaluate him.
- Onset: 5 hours ago
- Provocation/Palliation: nothing makes it better or worse
- Quality: "pressure"
- Radiation: "to my jaw"
- Severity: "it isn't that bad"
- Timing: constant
Your partner puts the monitor on the back seat and places electrodes while you get a set of vitals.
- Pulse: 150, weak at the radials
- BP: 102/68
- Resps: 22, unlabored, clear bilaterally
- SpO2: 94% r/a
As the initial rhythm strip prints and your partner places electrodes for a 12-Lead, you get a quick medical history.
- PMHx: hypertension, hyperlipidemia, palpitations
- Meds: "some pressure medication"
- Allergies: seasonal allergies, NKDA
- Last In's/Out's: breakfast
- Events: sudden onset of chest discomfort which woke him up this morning
Your partner hands you the rhythm strip and leaves to grab the stretcher as the 12-Lead prints.
You tear off the 12-Lead and the patient asks, "well, is something wrong with my heart?"
Your partner places the stretcher in front of the patient and says, "yessir, your heart is going too fast. Let's get you on our cot and into the back of our office so we can do something about that."
As you wheel the patient to the unit, your partner asks:
- What is our patient's rhythm?
- What did the 12-Lead show?
- How should we treat this patient?