Case Study (Jan. 27th, 2023)

🚨👉 You are dispatched to a male patient who is short of breath.

You arrive on scene to find your patient sitting on the toilet complaining of nausea and fatigue. You listen to his lung sounds and hear this… (crackles).

His wife mentions he just finished some house work, took 4 garbage bags out, and shovelled the driveway.

He has had 2 MIs in the past, has diabetes, and hypertension.

Vitals
👉 Skin Pale
👉 LOC Alert but fatigued
👉 Eyes PEARRL
👉: Resps 24 short and weak
👉 Pulse 146
👉 Temp 36.8 (98.5)
👉 BP 148 / 80
👉 BGL Normal
👉 SPO2 87%

❓ What condition do you think this patient has developed?
❓ Is this an oxygen problem, or a ventilation problem?
❓ What treatments should you focus on to help this patient?

Download our FREE note packs here! Interested in becoming a ⭐️ Paramedic student and making learning easier? Try out a free 3-day trial of our membership 👇

We also have an EMT exclusive membership called EMT Mastery, check it out here!👇

#emtstudent #emtschool #emt #emtlife #paramedic
#paramedicschool #paramedicos #paramediclife #paramedicscience #paramedical #shorts

[stoiiiboytoy]

Working diagnosis: CHF
Secondary: Anterior MI

Previous hx MI and HTN possible new onset CHF. Load and go. Apply ETCO2, start with NRB O2 at High-flow, 15LPM. Administer Nitro tab 0.4mg SL, 3-5min my local protocol allows up to 1.2 mg with 1 inch paste as long as systolic stays above 90. Reassess breathing if no improvement after O2 and nitro. Apply CPAP only if patient can tolerate and not vomiting. Establish IV. My local protocols allow for administration of 1 mg Midazolam for CPAP anxiety. Start CPAP at 5 cmH2O increase by 2.5-5 if needed up to 20cmH20. Reassess every 5 min. Administer Zofran 4 mg IVP for nausea and vomiting.

[susanfabina]

CHF.

Start oxygen by nasal cannula @ 3l. Check O2 sats. Check meds. Start an IV. NTG sl, bronchodilator by Ag and diuretic.

[chrystalselous]

Fluid overloaded as noted by the crackles in the chest, ecg showing STelevation

[irvincruz]

Might be CHF PE or MI I would give Cpap and maybe some aspirin to be safe

[glencmac]

ST depression, possible NSTEMI. Flash pul edema.
CPAP (15L/m) to try to dry the alveoli out. Nitro to reduce preload. Aspirin to reduce clotting. If in pain, morphine or ketamine.

[gagepoland]

With ST depression in the precordial leads a posterior ECG should be performed to assess for STEMI criteria

[glencmac]

NSTEMI, pulmonary edema. MONA, CPAP @ 15L/min. Immediate transport to nearest cath-lab.

[coldnorthAK]

Looks like ST elevation in AVR along with diffuse, ST depression. Wet lungs and HTN.
Full monitoring, pads, O2.
CHF exacerbation. Pulmonary edema.
Consider CPAP.

[thymetoheal]

pulmonary edema, oxygenation problem.
first position the pt upright and take off compression socks if he has any on. I would give him a CPAP/ BI-LEVEL treatment along with nitroglycerin spray of 0.4mg sublingual (if not allergic) conduct a physical exam to look for edema and or JVD

[danielsayre]

Pulmonary edema caused by heart failure, treat with oxygen considering both nasal cannula and cpap, and nitro, transport. Wish I could read the heart rhythms

[aidanrichardson]

Flash pulmonary edema, oxygen problem. CPAP Nitro

[weeziteer]

History of 2 MI’s and rales lung sounds has me thinking pulmonary edema. Capno., nitro., CPAP, 2 large bore IVs

[justincarrasquillo]

This patient clearly isn’t oxygenating because he has developed pulmonary edema. The sudden onset after exertion would lead me to think it’s being caused by something cardiac in nature along with his history. Maybe he has CHF and this is the first time something like this has happened. I would start him on CPAP.

[rosemadder]

Blood isn’t getting enough oxygen, so def a hart thing? I’m gonna go into guessing and say if blood isn’t getting oxygenated then maybe it’s based in the right ventricle? Nitro?