Acute chest and abdominal pain, h/o neurofibromatosis


• 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

Differential Diagnosis

• Working Dx: Chest Pain, Myocardial infarction, Anxiety, COPD, Acute on Chronic Pain syndrome, Narcotic seeking behavior (diagnosis of exclusion), Tumor pain, Costochondritis

Patient Workup History

• 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

Physical Exam

• 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

Editor’s Notes

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


• 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

Signs and Symptoms

Abdominal pain, chest pain, history chest wall tumors.

History Medical

• 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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