• Scene – Patient walked directly to medic
• En route – IV, CBG, 12 lead, vitals, Fentanyl for pain
• Hospital – Not known PIC – E. Williams Partner- B. Klein – EMT Intermediate Date 7/20/15
• Response to treatment – Fentanyl did not change pain level
• Disposition – Unknown
• Elliot Williams, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Type 1 neurofibromatosis
• Working Dx: Chest Pain, Myocardial infarction, Anxiety, COPD, Acute on Chronic Pain syndrome, Narcotic seeking behavior (diagnosis of exclusion), Tumor pain, Costochondritis
• Patient states – Chest pain. Patient was diagnosed with chest wall tumor 1 week ago, takes Vicodin for pain, not working any more.
• GCS – 15
• EKG – SR
• CBG – 67
• Tumors on skin 1-2cm and smaller covering entire skin.
• Atraumatic
• BBS CL equal
• Strong pulses
• Denies nausea, SOB, neck, back pain
• Abd is soft, non-tender
• Chest is atraumatic and symmetrical rise and fall
The medic did a nice job of the interview and requesting information from the patient about a condition not common to medics (the type of growths). It would be useful to obtain DNR status from this patient. I’m not sure how these medics were able to get a 12 lead, but it was clearly necessary. An aspirin may have been indicated depending on further ACS like Hx. And if the fentanyl was not effective, it should have been repeated.
-David Tauber, AS, EMT-P, Yale New Haven Sponsor Hospital Program
Hypovolemic shock
Myocardial Infarction
Neurofibromatosis type 1
• Age: 51 years
• Age: Not Available
• Height: Not Available
• Temperature: Not Available
• Blood Pressure: 119/78
• Heart Rate: 78
• Respiratory Rate: 18
• Pulse Oximetry: 100% RA
Abdominal pain, chest pain, history chest wall tumors.
• Type 1 Neurofibroma’s, 70+ tumors removed, including tumors on eyes
• Epilepsy
• Allergies
• Dispatch info: Abd Pain, history of chest wall tumors
• Lives with disabled mother, brother is care taker.
• Vicodin
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