Chest pain pt Turns into Covid & wont answer any questions

mrhunt

Forum Lieutenant
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So interesting call and wanted to see what you guys would have done and everyones feedback.

Code 3 for Chest pain. arrive to find mid 70's female Standing outside of door. States chest pain since 7:30am to fire on scene and Not much else. Leaves us to go back inside to grab something in the middle of fires assessment. Comes back out and just kinda sits on gurney. You can tell right off the bat this lady isnt Interested in talking, Its not that she cant its that she doesnt want to. She appears in minimal to moderate distress, answer A&0 questions appropriately and We get through OPQRST with a WHOLE lot of pushing and myself being a tad abrasive with alot of loud verbal stimuli and shoulder tapping.

Mind you pt ISNT altered and CAN answer questions, She's just remaining silent with no medical reason for it. She's not deaf and seems to hear me fine. No hearing aids, No language barrier. She just seems Sick and not wanting to talk, only selectively answering me and even then its ONLY yes or no answer's she gives . I go into Further assessment....Shortness of breath? Yes.
Nausea and vomiting? Yes. Diarrhea? Yes? .......I move to clear Covid Symptoms since she's stating Shortness of breath ......Cough? .....Yes. Loss of taste or smell? Yes. Pt seems to indicate EVERYTHING started today at 7:30am. Unable to obtain any further of flu like symptoms due to pt just not answering me.

****. So by this time were both in the back of the ambulance me and my partner in obviously very close proximity doing 12 lead, IV working it up as a cardiac and its taken so long to Get her to answer ANY questions or even hear what she's saying (often times its an extremely subtle head nod) that There's No Full PPE, Just surgical masks and Pt now has an N95 on. No going back now.

Vitals all unremarkable. 12 lead sinus with 1st degree block. She's a bit Diaphoretic, Lungs Clear. Unremarkable history...I think hypertension and thats about it. She denies recent travel or contact with anyone sick. Hospital treats as a PUI so we do the extensive decon to find out an hour later she's cleared, Negative covid by rapid testing. Given her presentation i wouldnt be suprised if she was an NSTEMI after all is said and done.


Afterwards my partner is like "well you were very pushy with her so she just said yes to everything". Well that wasnt the case, She had alot of complaints but denied questions as well. My partner said i was asking alot of leading questions..... Well open ended questions likely arent going to work on a pt that wont even state yes or no without Asking 5x a question, this lady wasnt in the mood for a conversation! My leading questions were likely "are you having shortness of breath?" "do you have a cough?" and so on and so forth. When i initially asked the question "is there anything else bothering you today?" Pt did not answer so that was a dead end. Do you NOT trying to do a more thourough assessment?.......Cause then when you show up to the ER with a pt that checks like 4 out of the 6 covid-19 symptoms The Er is gonna be PISSED and i'll look like total **** (worse than usual lol)

so What would you have done differently? what could I do differently next time?....We've all had pt's who just feel like not talking for whatever reason.....What, i show up at the hospital with literally no info? Thats not acceptable Under this circumstance when information WAS partially obtainable from the pt. I spend 20+ minutes on scene because she doesn't wanna talk and take huge amounts of time with letting her answer questions? No she's not load a go criteria but still.....
 
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mrhunt

Forum Lieutenant
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20
18
I mean he COULD have? But would be a bit counter intuitive considering the whole point of the Scenario was that i WASNT able to get a background ( and come to find out, apparently neither was the hospital aside from previous records)
 

DragonClaw

Emergency Medical Texan
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I mean he COULD have? But would be a bit counter intuitive considering the whole point of the Scenario was that i WASNT able to get a background ( and come to find out, apparently neither was the hospital aside from previous records)
True. I was shooting in the dark
 

Akulahawk

EMT-P/ED RN
Community Leader
4,550
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Sounds like some psych issues going on in addition to whatever is physically bothering the patient.
 
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mrhunt

Forum Lieutenant
149
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So follow up. Or got Ativan, stopped vomiting and was discharged with negative results on everything.

She was clearly never anxious in a typical presentation on scene but everyone is different.

Very odd call for sure.
 

Aprz

Forum Deputy Chief
Premium Member
2,598
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Treat it like an unreliable patient scenario (eg unconscious, altered, dementia). Sutton's law, go where the money is at, and focus on the objective assessment and diagnostics. You can keep asking the patient questions until you're blue in the face afterwards, and if they never answer you, you can just share you findings with the hospital and the fact that patient was uncooperative/not answering.
 

phideux

Forum Captain
432
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She just wanted the Medi-Uber to go shopping at the mall next to the ER.
 
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mrhunt

Forum Lieutenant
149
20
18
I mean......Were doing surgical masks and eye protection AKA personal shades in order to look thuper duper cool and establish my para-god authori-TAH. Lol.
 

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