BSI scene safety. My initial field impression is chest pain. I have one patient. I am going to
request additional ALS and transport. I am not going to consider c-spine at this
time. General impression of my patient is I have a 22 year old male
sitting in a chair holding his chest. He seems to be alert.
Hey sir what seems to be the problem? My chest has been hurting ever since I
started working and nothing has seemed to help. Chief complaint
of chest pain the fact that he's talking to me is lets me know that he's
maintaining its own airway. What I want to do now is I want to assess circulation
breathing, look at his respiratory rate for and his pulse for one minute. One eternity later.
I got a pulse rate of 88 strong and regular, respiratory rate of 18 non-labored.
Heart rate is 110, respirations are 29 and labored.
Okay what's the skin color, temperature, and condition of my patient? Cool, pale, and clammy.
Okay my patient is exhibiting signs of shock so I'm gonna have a
blanket on stand by, I'm gonna throw my patient on 15 liters of high flow oxygen
via non rebreather. Is any apparent bleeding going on? No apparent bleeding.
My patient is a high priority patient so we're gonna transport code three to the
hospital. Sir when did this pain or discomfort start happening. About
15 minutes ago or so. Does anything make it worse or better? Yes sitting down makes
it a little better but anytime I try to exert myself that all starts to get that
stinging pain again. Okay does it radiate anywhere? Yeah it kind of goes up
through the neck a little bit, in the shoulder. Okay on a scale of one to ten
ten being the worst pain you've ever felt what would you rate it? 10. Can you describe that
pain to me? Yeah it's kind of like a sharp like stabbing pain. Okay
and what time exactly you said about? 15 minutes ago? So has this ever happened
before? Yeah it's happened one other time I was
working out and it started to hurt real bad.
Okay so have you done anything in this in this case to alleviate that pain ?
No, I just just sat down and that's that's it haven't done anything. Okay are
you allergic to anything? No. No allergies? Okay what about your
past medical history? Nothing other than just this occasional chest pain anytime
I work out or exert myself. So any any medications? Nitroglycerin. Nitro.
How long have you been prescribed nirto? About a month. Okay last oral
intake, when is the last time you have eaten? About an hour ago I had breakfast. Okay
what did you have for breakfast? Eggs and toast. Okay what about the events
leading up to, so you said you were working out anything else that happened
out of the ordinary? No just I'd started to warm up I was getting ready to go for
a run and I started to kind of feel it start to hurt so I was working my way to
sit down and it just started hurting even more as I was walking so. So you've
mentioned a nitroglycerin you haven't taken any? No I haven't taken it. Okay so
what I want to do now sir, I'm going to palpate your chest. Let me
know if you have any discomfort when I press down. No. Okay I want to do,
I'm going to listen to you breathe when you take a few deep breaths. Okay
I'm going to listen to lung sounds that midclavicular, midaxiallary.
Okay deep breath.
Deep breath.
One more.
What I'm getting is clear lung sounds, all fields. Line sounds are clear. Okay
sir any discomfort or pain taking those deep breaths? No. Okay so any numbness, tingling
here anywhere, dizziness? a little bit of dizziness but other than
that no. Nausea vomiting? I haven't no. Headache? No. Okay alcohol or drug
use? No. Okay I'm gonna get vitals. I am going to get a blood pressure. I am going to check your blood pressure sir.
I got 128 over 88. Blood pressure is 120 over 82.
120 over 82 heart rate at 110 strong and regular and respiratory rate at 29 and
labored. My field impression, my patient isn't dealing with any type of
pulmonary episode, I think it's a cardiac in nature. I understand that my patient is
prescribed nitroglycerin. It's in his name and it's date is accurate. My
patient is a candidate for baby aspirin, nitroglycerin, and oxygen therapy that I'm
already giving him. Now I'm going to do is I'm going to contact medical
control and see if they approve of me giving my patient an aspirin and nitroglycerin
based off of his blood pressure being at over a hundred 100 systolic.
So I'm going to call them for direction let them know that I have a 22 year
old male who is exhibiting a little bit of chest pain due to exertion. Says he
has a history of it. It happened 15 minutes ago.
Vitals are 120 over 82 pulse is 110 strong and regular and respiratory rate of
29 labored and see if they advise. Medical control does not permit. Okay so
I'm just gonna put my patient in position of comfort, keep giving them
oxygen therapy via non-rebreather 15 liters. Reassess my patient every five
minutes because he is based off of his severity and I'm going to give my when
we arrive to the hospital I'm going to give the receiving nurse or doctor the basic
report of I have a 22 year old male who's experiencing exertional angina,
has prior experiences with this episode and happen about 15 minutes ago he is
prescribed nitroglycerin, he hasn't taken any. We have just been giving him oxygen
therapy, position of comfort and transporting him here.
Vital signs were 120 over 82, pulse is 110 strong regular, respiratory rate is
29 labored. That's it.