It's a quiet Sunday afternoon when you're dispatched to a residence for a 77 year old female complaining of abdominal pain. Your dispatch notes indicates she was at the ED the day prior. Upon your arrival, you're met on the porch by the patient's son who directs you inside.
Your patient is sitting in a recliner, with mild respiratory distress, clutching her abdomen. Her skin appears a bit moist, and is warm when you touch her arm to feel for a radial pulse. When you ask her what is going on, she simply replies, "my belly won't stop hurting."
Your partner makes quick work of her vitals while you get the run down on her history.
- Signs/symptoms: 7 of 10 abdominal pain going to her back, belching, intermittent vomiting
- Alergies: Codeine
- Medications: lisinopril, metoprolol, furosemide, potassium chloride, magnesium oxide, lipitor, albuterol, vitamin supplements, metformin, iron
- PMHx: renal failure with dialysis (shunt Rt arm), hypertension, hypercholesterolemia, type II diabetes, pacemaker, asthma
- Last ins/outs: vomiting x 3 today, did not do dialysis on Friday due to nausea/vomiting
- Events: progressive worsening of pain and nausea
Your general impression of the patient is she just looks unwell. Your partner relays her vitals.
- Pulse: 80 bpm, irregular
- BP: 210/100
- RR: 24, wheezes
- SpO2: 94% on room air
- T: 99.1 F (37.3 C)
- BGL: 194 mg/dL (10.7 mmol/L)
Her son asks that you take her to the smaller, local hospital so, "she does not have to wait as long as she did at the ED yesterday." When you ask for her discharge instructions, he can only find the sheet which says Chest Pain and very generic information.
When you ask about her pain earlier, she denied any chest pain, however, to be prudent you obtain a 12-Lead:
You assist her to your stretcher, securing her with seat belts, and begin moving her to the truck.
- What does this patient's 12-Lead ECG show?
- What is this patient's rhythm?
- What are your treatment priorities?
- Can you still take this patient to a community hospital?