Call Details
PMED 1010 Case Study
It’s 1500hrs and you are sent Code 4 to a 72-year-old male complaining of chest pain.
As you enter the residence you’re directed to the bedroom. During your scene survey you
notice that the bed is made, however there are several pillows on one side of it. You also note
that the head of the bed is sitting on two blocks of wood.
You see your patient sitting in his bedroom on a chair. You note obvious work of breathing, and
that he is clutching his chest. He appears pale in colour and diaphoretic. He is restless as he is
sitting in the chair, appearing anxious and distressed.
The patient’s wife informs you that he has not been sleeping well the past few days due to
“feeling short of breath at night”. He is usually an active man who works around the house
however she has noticed this past week that he is unable to complete most of his chores
because he starts to have pain in his chest-this pain is usually resolved when he rests and takes
his Nitro Spray.
Today the patient began to feel chest pain again, but this time it was while he was at rest. He
took his Nitro x3 sprays, however the pain did not go away. His wife became concerned when
she saw how uncomfortable he looked, so she called 911.
He is compliant with his medications and takes them as prescribed.
Past Medical History
Angina
CHF
Hypertension
Diabetes
High cholesterol
Vitals & Pain Assessment
Medications
Metformin
Metoprolol
Nitro Spray
ASA
Furosemide
Atorvastatin
Allergies
NKDA
| BP | 172/95 | O | Today, while at rest |
| Pulse | 68, regular | P | Pain/discomfort is constant, does not change with breathing, movement or palpation |
| Resp Rate | 20, regular | Q | Heavy, ache |
| SpO2 | 97% | R | Into Left arm, upper back between shoulders and into jaw |
| Temp | 36.7 | S | 8/10 |
| BGL | 6.8 | T | Today’s episode started ~1hr ago |
| Skin | Pale/cool/diaphoretic |
Physical Exam Findings
| Head and Neck | JVD present. Trachea midline. Patient complaining of pain in his lower jaw (originates in chest and radiates up) |
| Chest | Fine crackles noted bilaterally in the bases on auscultation. Accessory muscle use noted, 3-4 word dyspnea is noted when he tries to speak. Patient complaining of 8/10 retrosternal chest pain with radiation to his Left arm and jaw. Pain described as heaviness. Onset of pain was at rest today, however throughout the week he has been having pain while doing chores. No trauma noted. |
| Abdomen | Soft on palpation. No pulsating masses noted. No nausea or vomiting. |
| Back | “achiness” described in upper back between his shoulders |
| Pelvis | Unremarkable |
| Extremities | Bilateral pitting edema noted in his ankles. Strong radial and pedal pulses noted |
12-Lead
*Analysis= STEMI, with ST elevation noted in the inferior leads. Reciprocal changes
noted. Possible posterior involvement, where a 15-lead will be required for full
analysis.
Using the textbook, lectures, and your research, answer the following questions
about the relevant pathophysiology and the patient described above. The marking
rubric is shown in Canvas.
1. Explain the pathophysiology of atherosclerosis development and how it could cause a
myocardial infarction.
2. Compare and contrast angina and myocardial Infarction. Discuss the pathophysiology of
each, including the similarities and differences in typical patient presentation. Does
your patient appear to fit in one of these categories? Explain your answer.
3. Define right sided heart failure and left sided heart failure. What are the “forwards”
and “backwards” effects of each? . Based on your patient information, do you expect
this patient to be in right-sided or left-sided failure? Why?
4. As the attending paramedic, what are your top 3 differential diagnoses for your
patient? What are your priorities when treating and transporting this patient?