Monday, January 06, 2014

Just "a little trouble breathing"

Dispatched for "Difficulty Breathing".

It's a fall night, and the call is down the street. Response is quick and uneventful.

On arrival, I find a 40's male lying in bed. His son says he called 911 against his father's insistence that he's fine. The son says his dad doesn't look right, and seems to be in more distress than he's letting on. I look at the patient, and the son is right... He "looks sick" and says he's having some shortness of breath, and notes he was out in the yard raking leaves all day. Lung sounds are clear, initial B/P ia on the low side of normal but not below 100 systolic, and his heart rate is running at about 90 fora relatively   healthy male lying supine. I ask if he's having any chest pain. He denies it. I press further, and ask if anything else is bothering him. He says his chest feels "tight" and it's uncomfortable to take a deep breath.  I ask him to rate his chest pain on a 1-10 scale, and he remains insistent that he's not having any chest pain.  Sure. Fine. Just tightness. So can you rate your tightness? "7/10". Gee. Now I'm getting somewhere. 

I run a 12-lead. The monitor alarm kicks on saying "acute MI". I look at the strip. Massive ST-segment elevation in V3 and V4, with other changes. Ding Ding Ding. The monitor is, shockingly enough, correct. The patient appears to be having a MI.

I silence the alarms, we package the patient and get him to the truck. Patient gets an IV, some nitroglycerin under his tongue with minimal response, and asks "what's going on".

My response? Sir. You appear to have a blockage in an artery that feeds your heart - a heart attack. I'm going to try to give you some medication to make you feel better, and we're gonna get you to the Hosptial, where you're likely to be undergoing a cardiac cath pretty quickly.

We start transporting. It's a 20 minute ride to the ED... I transmit my EKG and give the ED a phone call advising of our impending arrival. I start a second IV, give more nitro, some saline, Zofran for nausea, and then finally some morphine to ease his pain, which starts to fall a little.

On arrival in the ED, they did a repeat 12-lead (per their protocol) and then we went right upstairs with the patient still on my stretcher.

I gave a report to the arriving cath lab team, transfer the patient to the table, and then left. In follow up, the Pt. received multiple stents but was discharged without incident. Calls like this are "wins" for EMS - we recognize the problem and seek the appropriate treatment.

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