This great case comes from a long time reader who wishes to remain anonymous. As always, details have been changed to protect patient and provider privacy.
You're dispatched on an ALS quick response vehicle by law enforcement requesting EMS to check up on a subject. Dispatch notes indicate officers were called reference a domestic disturbance and have two subjects in custody. A BLS ambulance just around the corner from the call checks on scene and requests ALS continue.
You're directed into a small apartment by an officer and find the BLS crew obtaining vitals from a young man, who appears pale, seated on a couch, uncuffed. The officer says, "he started complaining of chest pain and his hands tingling after we arrested him, might be an anxiety attack. He and his girlfriend really got into it."
You check in with the BLS crew who are obtaining his vitals and introduce yourself to the patient. He looks up at you and simply states, "It's SVT."
One of the crew looks up and nods his head while giving the vitals:
- Pulse: too fast to count
- BP: 118/64
- Resps: 18, unlabored
- SpO2: 94% r/a, cap refill normal
- JVD: moderately elevated
A quick assessment is made:
- Signs and Symptoms: Palpitations and SOB
- Allergies: None
- Medications: None
- PMHx: "I've had SVT a lot, like twice already this month."
- Last In's and Out's: Dinner
- Events: verbal altercation with girlfriend
During your exam the BLS crew has placed the patient on the monitor for you:
As it prints out, you tell one of the officers that he's definitely a patient and will be going with you to the hospital.
A 12-Lead is acquired:
- Is this patient actually in SVT?
- What is your treatment plan?
- What sort of medical problems could this patient have?