59 Year Old Male: Unwell

It’s the middle of the afternoon when you are dispatched to the residence of a 59 year old male with a chief complaint of general illness. When you arrive on scene you encounter a middle-aged man in obvious distressed lying on a couch. He is pale, gray, diaphoretic, and drowsy. He states that he has felt drained for the past 8 hrs; unable to catch his breath or get up off the couch with a heavy sensation in his chest. 30 minutes prior to your arrival he vomited and felt like he was going to pass-out so he decided to call 911. His radial pulse is faint, rapid, and irregular while his skin cold and moist. HR – 150 bpm, irregular SpO2 – Unable to get a clear waveform BP – 72/42 mmHg RR – 26. labored Temp – 36.6 C (97.9 F) Breath sounds reveal crackles bilaterally. Multiple 12-lead ECG’s are performed but suboptimal due to the patient’s increased work of breathing and inability to stay still. This is the best of the bunch: BGL is 156 mg/dL. He is a bit lethargic but properly oriented and answers questions appropriately, albeit slowly. S – As above A – No known drug allergies M – None P – Appendectomy @ 24yo L – Soup 45 min prior, which he vomited soon after E – Can’t recall—states he has felt terrible “all day.” Regarding the chest heaviness… O – Gradually through the morning P – Nothing makes it better or worse Q – Heaviness R – None S ̵...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Cases Vince DiGiulio Source Type: research