Not Just Acid Reflux: The Need to Think Worst First

A previously healthy, well-appearing 42-year-old female living in a modern, high-rise apartment in downtown Los Angeles calls 9-1-1 at 5:30 am complaining of worsening of a burning, epigastric pain she had been experiencing for the last three days. She reports associated nausea and non-bloody, non-bilious vomiting, and that she couldn’t manage to get comfortable in bed until she finally decided to call for help at daybreak. During her 9-1-1 call, she reports “pain, like heartburn, that just woke me up again and I had to throw up, … and then I was sweating so much.” Using the Los Angeles Tiered Dispatch System, the 9-1-1-telecommunicator couldn’t discern whether the patient was actually having abdominal or chest pain and opted to dispatch a chest pain (age> 40) dispatch code, launching a paramedic unit from the busy downtown fire station. Upon arrival, paramedics find a young, fit-appearing Hispanic female sitting in her living room, reporting a “burning sensation in her throat.” She tells medics that she has a history of acid reflux but states that she wasn’t having any relief with her usual Tums. She also states that she usually feels like this after drinking alcohol, and that she had a few drinks last night and smoked some marijuana. Her vital signs are within normal limits, her abdominal exam was benign, and she requests “something to help with her reflux,” but she ultimately refuses transport to the ED. No fu...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

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