Patient With Chest Pain and Shortness of Breath Shows Standardized Treatment Doesn't Work for All Patients

John, a 65-year-old male, is sitting in a chair in the corner of the room as you and your partner enter his house. John tells you he's the only one home and called 9-1-1 because he can't breathe and his chest is killing him. His skin is ashen and his breathing is rapid. You can palpate a weak irregular pulse and you note his skin is warm and diaphoretic. He describes his shortness of breath as increasing in severity over the last couple of hours with the chest discomfort. With a pulse oximetry reading of 78% on room air, you apply oxygen via a non-rebreathing mask. Physical exam reveals bibasilar crackles on pulmonary auscultation. His pulse rate is 86 and remains irregular, blood pressure is 84/68 and he's tachypneic at 24 breaths per minute. He says he feels dizzy but can't breathe when he tries to lie down. He does say the oxygen is making him feel better and his pulse oximetry reading has increased to 91%. Your partner collects John's prescription medications, which include Lopressor (metoprolol), Crestor (rosuvastatin), aspirin and nitroglycerin. You and your partner quickly realize this patient is critical and advanced level care is needed. You decide to begin transporting to the closest hospital, which is 30 minutes away, and rendezvous with the ALS EMS service in the next county on the way. John is breathing better with the oxygen but he's still short of breath with chest pain. His blood pressure is too low for him to receive nitro or continuous positive airway pressu...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Columns Patient Care Source Type: news