Dyspnea After Small Electrical Fire Puzzles Medics

Gary, a 47-year-old male, is at home. A typical summer thunderstorm develops, and during the storm his house is struck by lightning and the power goes out. Gary notices the smell of smoke and goes to his basement to investigate. He notices smoke coming from his main breaker box, with a small fire above it. He opens the box and attempts to extinguish the fire unsuccessfully. He retreats to the main level of the house and calls 9-1-1. The Call The first engine company and medic unit arrive in six minutes, and light smoke is now showing. Gary is standing in his yard directing the units to the fire source. The fire is brought under control in about 10 minutes. The engine companies and Medic unit remain on scene and assess Gary, who states he's fine and declines treatment or transport. However, Gary returns to the medic truck 15 minutes later stating he's having difficulty breathing, so he's placed in the ambulance and reassessed. Gary has a history of hypertension and heart disease. He's awake and oriented, pale and diaphoretic, dyspneic with bilateral expiratory wheezes, and has a respiratory rate of 22. Other vitals are a blood pressure of 154/82, heart rate of 102 and pulse oximetry of 91%. A 12-lead ECG shows sinus rhythm without ST segment changes. Gary agrees to be transported and is taken to the closest hospital, Augusta Health. In the ambulance, he's placed on supplemental oxygen by non-rebreather at 12 Lpm along with IV access by saline lock, and albuterol and Atrovent (...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Case of the Month Medications & Pharmacology Patient Assessment Toxicology Source Type: news