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: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research