Chest pain

[EMT B]

Dispatched at 17:32 for a 17 yo female with chest pain. get on scene to find the patient laying on the couch. pt appears to be about 5'6 and 110 lbs, She appears sligtly diaphoretic. patient states she was having "chest pains around her heart and was having painful shocks down her left arm and her neck". the mother states the pain is common but never this bad.

bp: 119/71
hr: 102
SpO2: 97%

heart and lung sounds all were normal. administered 325mg ASA with no releif. called ALS. ALS does a 12 lead ekg which shows sinus tachy.

pt is transported in position of least discomfort.


what do you guys think it is? im stumped.

 

[Thricenotrice]

Did they give nitro? How was the pt presenting? Overall presentation, how bad was the pain, quality, all the opqrst stuff?

You said the pain is common? What is the history, any defects, so on?

Need a better painted picture

 

[Aidey]

Anxiety.

 

[JPINFV]

Medical history?
Have someone pull the mom into another room for "questioning" and ask the patient about tobacco, alcohol, drugs, sex.

Also, ASA isn't administered for pain control, so I wouldn't expect relief even if it was a MI.

 

[NomadicMedic]

Anxiety.

I would not give ASA or NTG.

 

[Anjel]

Was she breathing hard? Or just laying on the couch chilling?

What was she doing when it started?

I'm going with anxiety and a BLS transport, if med control will allow.

 

[abckidsmom]

Anxiety.

Anxiety.

I would not give ASA or NTG.

17 yof + mom, and a cell phone. You're seeing an anxiety show. A few digging questions can identify who the show is for.

 

[RustyShackleford]

MID call.......Muffin In Distress

 

[mycrofft]

Caffeine level??

1. Was pulse regular? Was it by palp or auscultation?
2. Was EKG automated or over-read by human, and did it include a rhythm strip?

 

[EMT B]

the onset was about 15 mins prior to our arrival. she was watching tv. respirations were normal. nothing makes it better or worse. she does have a history of this happening but the doctor didn't know what it was. pain was a 9/10. like i said the pain radiated to her neck and left arm.

she last had a coffee friday morning at school. she does not regularly drink coffee. also she is not sexually active, she does not smoke, however she has had alcohol before. the last time was 3 months ago at a party with her friends. she had 2 shots of vodka, a glass of boxed wine, and a bottle of gatorade.

unfortunately i do not have the ekg printout :/

pulse was regular by palp

 

[JPINFV]

she last had a coffee friday morning at school. she does not regularly drink coffee. also she is not sexually active, she does not smoke, however she has had alcohol before. the last time was 3 months ago at a party with her friends. she had 2 shots of vodka, a glass of boxed wine, and a bottle of gatorade.

Was the social history taken in front of any of the patient's parents?

 

[EMT B]

no it was done during transport

edit: mom drove to the hospital in pov

 

[mycrofft]

Good on the pulse. I assume the EKG was an automatic reading , like the one that called my a-fib "Occasional PVC'S, sinus rhythm".

PAT maybe?

 

[EMT B]

no, the paramedic read the ekg strip and said sinus tachy.

edit: also i dont think its PAT because her resting heartrate is usually in the 90s (from the mother). i also have no reason to believe she lied about the drugs or the sex because she told us the truth about the drinking

 

[EMT B]

I suggest you post this question in the relevant thread so that everyone can see the question and answer.

What does anxiety have to do with that call? How did you come to that conclusion?

from pm

 

[Clare]

Aspirin would not be overly harmful and if it is myocardial ischaemia secondary to coronary artery occlusion it would confer benefit

I do not think it is myocardial ischaemia and it is most likely idiopathic or psychosematic

 

[EMT B]

i was just going by protocol. chest pain and pain in the left arm and neck/jaw area gets asprin

 

[Aidey]

Your protocol very likely means cardiac related chest pain. If someone got punched in the chest and left arm would you give them ASA?

 

[Clare]

i was just going by protocol. chest pain and pain in the left arm and neck/jaw area gets asprin

I also agree that this means suspected myocardial ischaemia, if there is not objective evidence of myocardial ischaemia then you should not be treating for it

 

[EMT B]

well yes i thought it was cardiac, however ALS did not, and I was wondering how you guys came up with Anxiety