Right sided chest pain

[Burritomedic1127]

Get called for mid 50s yo male complaining of 8/10 right sided non radiating dull pressure with increasing shortness of breath on exertion. You find the pt sitting in a chair Alert x 4 Breathing 20 per minute, Strong radial pulses in the 100s, skin is diaphoretic. Sinus tach on the monitor and hypertensive, here's the 12:

 

[Scott33]

S1 Q3 T3 with sinus tach and SOB. Needs a w/u for a PE.

 

[Burritomedic1127]

Good idea with S1 Q3 T3, thought the same but no.

 

[Burritomedic1127]

Pt has hx of previous MI, 3 bypass, HTN, and hyperlipidemia

Takes ASA and rate controlled with metoprolol

 

[STXmedic]

S1Q3T3 is more Cor Pulmonale than just PE. Depression in V5 V6 with elevation in aVR, I'd like to see a right sided 12 lead. Lung sounds? Oxygen saturation?

 

[Burritomedic1127]

Right sided 12 lead unremarkable (dont have copy) lungs clear in all fields, 92% on RA, jumps to 95% on 2 lpm NC.

Administered 243mg ASA and one sublingual 0.4mg nitro with pain relief and slight improvement of hypertension

Thinking STEMI or no?

 

[Gurby]

As a medic student, my first thought was obvious anterior MI? I'd like to see a BGL. Aspirin, nitro, O2 based on sat.

My second thought was that I really need to put more time into studying EKG's over winter break! My third thought was that I'm glad we have telemetry...

 

[Ewok Jerky]

Not sure where my reply from yesterday went...but to sum it up.

If there is a fever too this scenerio is textbook PE. Not saying it's a slam dunk but that's high on my list.

R sided 12-lead is negative could be NSTEMI. Could be septic too.

She's tolerating CPAP? Good. C3 to cardiac facility, ASA, nitro, and a face mask/gown because it's about to hit the fan.

 

[EMT11KDL]

Right sided 12 lead unremarkable (dont have copy) lungs clear in all fields, 92% on RA, jumps to 95% on 2 lpm NC.

Administered 243mg ASA and one sublingual 0.4mg nitro with pain relief and slight improvement of hypertension

Thinking STEMI or no?

Are you a little dyslexic?

I am running on the PE side of things, any recent surgery/trauma/Falls?

 

[Ewok Jerky]

Post op day 3 in original post

 

[MonkeyArrow]

Post op day 3 in original post

You, like me, are getting the two scenario threads confused. This is a separate one than the CPR in progress thread started by @teedubbyaw. That one does have the 3 day post-op PE deal.

 

[Ewok Jerky]

You, like me, are getting the two scenario threads confused. This is a separate one than the CPR in progress thread started by @teedubbyaw. That one does have the 3 day post-op PE deal.

Haha, so that's where my reply went.

 

[Burritomedic1127]

Are you a little dyslexic?

I am running on the PE side of things, any recent surgery/trauma/Falls?

Dyslexic?

PE was a high differential. Only surgery was a triple bypass about 15 years prior, no trauma

 

[EMT11KDL]

Dyslexic?

PE was a high differential. Only surgery was a triple bypass about 15 years prior, no trauma

For ASA you wrote like 243

 

[Burritomedic1127]

Haha, so that's where my reply went.

Strangely your answer works. Pt was treated as a STEMI by EMS. 12 lead transmission, ASA, Nitro. Myself and the med control MD I spoke with were most concerned about the somewhat global non specific depressions with elevations in aVR and V1, with V1>aVR. But cardiology thought different...go figure...and the cath lab was not activated. But he was having an NSTEMI with an ejection fraction about 15%

So beano for the half win??

 

[Burritomedic1127]

For ASA you wrote like 243

Ahhh I get you. Nah wasn't my dyslexia kicking in haha it was the Pt already took one 81mg ASA prior and we gave 3 81mg ASA to reach our max dose of 324

 

[EMT11KDL]

Ahhh I get you. Nah wasn't my dyslexia kicking in haha it was the Pt already took one 81mg ASA prior and we gave 3 81mg ASA to reach our max dose of 324

Gotcha, I am now picking up what you are putting down, I thought your computer likes to jump to different spaces like mine does when I am trying to type.

 

[Burritomedic1127]

Happens all the time. If I didn't double check my post earlier, that Pt was starving an NSTEMI.

Professional fat kid status when your autocorrects are food related