Cardiac Case Study: Year-Old Male with Chest Pressure | EMS World


ems case studies

EMS CASE STUDIES • Critical thinking and clinical diagnostic skills are a vital component to patient care • Traditional medical training is disease -based and focuses on textbook learning • Changing to patient -centered teaching, where we use our powers of reasoning, clinical examination skills and. Sep 01,  · Use this case study as an educational tool by answering the questions posed by the author, then reviewing the answers further down. At . Chest and Abdominal Trauma Case Studies Case #1 Scenario: EMS is dispatched to a 2-car MVC with head on collision. The posted speed limit is marked at 40 MPH. Upon EMS arrival to the scene an unrestrained adult driver is found inside the vehicle with noted + steering wheel.

Pediatric Case Study for Paramedics: 7-Year-Old Female with Difficulty Breathing

Use this case study as an educational tool by answering the questions posed by the author, then reviewing the answers further down. At a. You and your partner proceed to the scene, with a response time of approximately eight minutes, ems case studies. The closest hospital from the scene is 40 miles away. You arrive at the scene, don appropriate BSI precautions and ensure that the area is safe, then knock on the door of the patient's residence.

A middle-aged male answers the door and identifies himself as the patient. You note that he is diaphoretic and anxious, and is clenching his fist against the center of his chest. What is the significance of the patients clenched fist in the center of his chest? You sit the patient down and perform an initial assessment Table I. Your partner attaches a pulse oximeter and prepares to administer oxygen to the patient, ems case studies. The patient tells you that his doctor prescribed nitroglycerin for him; ems case studies, because he recently moved into the ems case studies, he ems case studies it's still packed in one of the boxes.

Level of consciousness: Conscious and alert to person, place and time; restless and anxious. Chief complaint: "My chest feels tight and I feel really weak. Circulation: Radial pulse is rapid, strong and regular; skin is cool, clammy and pale. Onset: "This began suddenly. It woke me from my sleep. Nothing that I do makes it better or worse. I don't hurt anywhere else. Time of onset: "This began about an hour ago. Chest exam: No sign of trauma, chest wall is symmetrical and nontender.

Breath sounds: Clear and equal bilaterally to auscultation. Jugular veins: Normal, not distended. After confirming no history of bleeding disorders or allergies, ems case studies, you administer mg of aspirin to the patient.

The patient remains conscious and alert, but is becoming increasingly restless. You attach the patient to a cardiac monitor and interpret his cardiac rhythm as sinus tachycardia at beats per minute. After administering 0, ems case studies. As your partner stands up to retrieve the stretcher from the ambulance, you tell him that it looks as though the patient may be having an anterior wall MI.

Signs and symptoms: Chest pressure, restlessness, diaphoresis, tachycardia, hypertension. Allergies: None. He is not allergic to aspirin, ems case studies. Medications: Nitroglycerin as needed and Vasotec. He has not taken any Viagra.

Pertinent past history: "I have high blood pressure and the doctor told me I may have a heart attack if I don't start exercising, ems case studies. He gave me the nitro to take when I have ems case studies pain. How could this patient's current blood pressure and heart rate affect his condition? The patient's chest pressure is unrelieved following two more doses of sublingual nitroglycerin.

You place him on the stretcher and load him into the ambulance. En route to the hospital, you continue oxygen therapy and successfully establish an IV of normal saline with an gauge ems case studies. Because three doses of nitroglycerin failed to relieve his pain, you administer 2 mg of morphine sulfate via IV push, ems case studies. Within 10 minutes, the patient tells you that the pressure in his chest has improved and is now a "3" on a scale.

The patient's condition continues to improve en route to the hospital. You ask him if he has a history of ulcers, bleeding disorders, recent surgeries or stroke. He tells you that other than his high blood pressure and occasional chest pain, he has no other medical problems. You call your radio report to the receiving facility and continue to monitor the patient.

Level of consciousness: Conscious and alert to person, place and time; less restless. Chest pain severity: 3 on a scale, ems case studies.

The patient tells you that he is still experiencing chest pressure; however, it is less severe. You continue to monitor the patient's vital signs and cardiac rhythm. Your estimated time of arrival at the hospital is minutes. Upon arriving at the emergency department, the patient states that he is pain-free. You give your verbal report and field-obtained lead ECG to the attending physician. Following additional assessment in the emergency department, the patient is diagnosed with an acute anterior wall myocardial infarction.

Following successful treatment with fibrinolytic therapy, he is ems case studies to the cardiac care unit and transferred to a cardiac rehabilitation facility 10 days later. Ischemic cardiac chest pain is typically described as being crushing, tight, oppressive, pressuring or constricting in nature.

Patients may describe their pain as though a vise were placed around their chest or the sensation that an elephant is sitting on their chest, while others may only report ems case studies vague or "strange" sensation in their chest. The pain associated with cardiac ischemia is usually substernal; however, it may be localized to the epigastrium and is commonly mistaken for indigestion, ems case studies.

A clenched fist in the center of the chest the precordium conveys the feeling of pressure or squeezing and is called Levine's sign see the photo on page The presence of Levine's sign is suggestive, but not conclusive, of cardiac-related chest pain and should increase your index of suspicion. Elderly patients and patients with diabetes may present without classic symptoms or with only vague, nonspecific symptoms, such as malaise, ems case studies, lightheadedness, syncope, changes in mentation or sudden diaphoresis.

Patients with cardiac ischemia may also present ems case studies referred pain to other areas of their body, such as the jaw, arm, shoulder or back. Less commonly, patients may present with atypical chest pain, which may be described as sharp or stabbing in nature. During your general impression of the patient with chest pain or pressure, look for clues suggestive of cardiac compromise, such as diaphoresis, restlessness or apprehension.

The absence of chest pain or the presence of atypical chest pain, ems case studies, however, does not rule out an ACS--especially if the patient has other signs and symptoms and a history of cardiac disease e. Acute coronary syndrome is a term used to describe many types of compromised circulation to the heart muscle, including unstable angina pectoris or acute myocardial infarction. Because the clinical presentations of the two are extremely similar, if not identical i, ems case studies.

Before discussing the physiologic effects of nitroglycerin, a brief review of coronary atherosclerosis, ems case studies, myocardial ischemia and angina pectoris is in order.

Coronary atherosclerosis is a progressive disease characterized by the buildup of lipid-laden plaque within the lumen channel of the coronary artery. Atherosclerosis causes narrowing of the artery decreasing coronary blood flow and hardening of the artery limiting the ability of the artery to dilate.

These negative consequences of atherosclerosis reduce the ability of the heart to accommodate increases in myocardial oxygen demand, such as that caused by stress or exertion. When the scale of myocardial oxygen supply and demand is unbalanced, the patient develops ischemic chest pain or pressure angina pectoris. Ischemia, which is defined as a relative deprivation of oxygen, occurs when oxygen demand exceeds supply, and is ems case studies reversible condition with prompt treatment.

Angina is described as being stable or unstable. Stable angina is characterized by a relatively predictable sequence of events. Patients are often aware of the extent of exertion that precipitates their chest pain e. Additionally, patients are also aware of what they need to do to resolve their symptoms e. Following resolution of their chest discomfort, many patients with stable angina never call EMS. Unstable angina occurs when ems case studies patient experiences a change in his typical anginal pattern, indicating advanced coronary atherosclerosis and an oxygen supply-demand mismatch that is not so easily balanced with rest and nitroglycerin.

Relative to stable angina, the patient with unstable angina experiences "off-pattern" chest pain, such as when exertion is minimal or when myocardial oxygen demand is otherwise low e.

This change may prompt a call to EMS. Nitroglycerin NTG causes relaxation of vascular smooth muscle vasodilationpromoting systemic pooling of venous blood. This decreases the volume of blood that is returned to the heart preloadas well as the amount of resistance that the heart must pump against afterload. The combined effects of decreased preload and afterload cause an overall decrease in myocardial oxygen demand and consumption. Additionally, nitroglycerin may dilate the coronary arteries and promote collateral circulation, thus improving oxygen supply to the ischemic myocardium.

Collateral circulation, also referred to as "arteriogenesis," is a process in which smaller arteries that are normally closed become patent open up and connect two larger arteries or different parts of the same artery.

Over time, myocardial ischemia can promote collateral vessels to grow, forming a "detour" for blood flow around the blocked coronary artery. Because nitroglycerin dilates the systemic blood vessels, it can result in hypotension.

Therefore, its use is generally contraindicated in patients with a systolic BP of less than 90 mmHg, as well as in patients who have taken Viagra sildenafilLevitra vardenafil or Cialis tadalafil within the past hours.

These drugs, which are used to treat sexual dysfunction, also cause vasodilation and, when used concomitantly with nitroglycerin, ems case studies, can result in potentially life-threatening hypotension. EMS providers should follow local protocol or contact medical control as needed regarding the use of nitroglycerin.

This patient's history, physical examination and lead ECG findings suggest acute myocardial infarction AMI involving the anterior front wall. Epinephrine increases the rate chronotropy and strength inotropy of cardiac contractions and norepinephrine increases systemic blood pressure by constricting the blood vessels, ems case studies.

This patient's vital signs represent a classic case of "more is not better! Additionally, an elevated blood pressure increases afterload ventricular resistancefurther increasing myocardial oxygen demand. Unfortunately, in this patient, an occluded coronary artery is blocking the flow of oxygenated blood to the area of the myocardium that needs it most--the injured area. This increase in myocardial ems case studies demand and consumption and decrease in myocardial oxygen supply can enlarge the area of injury, resulting in greater myocardial damage.

The anterior wall is the largest part of the heart and tends to sustain significant damage as the result of ems case studies MI. As the area of injury increases, lethal cardiac dysrhythmias, such as ventricular fibrillation v--fib or ventricular tachycardia v--tachcan occur.

Additionally, if an extensive ems case studies of the anterior wall is damaged, the patient can develop acute CHF and, in more severe cases, cardiogenic shock.

Cardiogenic ems case studies, which has a very high mortality rate, occurs when the heart is severely damaged and is no longer able to adequately perfuse the body.


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ems case studies


Pediatric Case Study for Paramedics: 7-Year-Old Female with Difficulty Breathing At a.m., your unit is dispatched to Fabra Elementary School for a 7-year-old female with difficulty breathing. Chest and Abdominal Trauma Case Studies Case #1 Scenario: EMS is dispatched to a 2-car MVC with head on collision. The posted speed limit is marked at 40 MPH. Upon EMS arrival to the scene an unrestrained adult driver is found inside the vehicle with noted + steering wheel. Interactive Case Studies of alarms commonly seen on campuses across America with a twist you hear “EMS Charlie response: female respiratory difficulty in the gymnasium at the student sports Microsoft PowerPoint - caria - ems case