Acute onset, Chest Pain and Dyspnea


• Oxygen, Albuterol MDI prior to arrival • IV access


Dennis Russell, M.Ed, ATC, CSCS, NRP, CP Paramedic Educator United Ambulance, Lewiston, Maine


Merlin Curry, MD University of Arizona

Differential Diagnosis

• MI, COPD exacerbation, bronchitis, Congestive Heart Failure, Pulmonary Embolism, Anxiety (dx of exclusion)

Key Points

• Get a good history regarding this unusual finding. The hospital staff will have all the same questions you do, and if you have clear, reliable answers then they can quickly move beyond this finding and treat the underlying cause.
• Retractions often mean airway obstruction, often in the small lower airways (asthma, COPD) which often manifests as wheezing, or in the large upper airways (foreign body, upper airway swelling such as allergic reactions, epiglottis) that often presents as stridor or crowing on inhalation.

Editor’s Notes

• Unusual and complicated surgical history, should not detract from the basics and common problems are still common. Assess for cardio-respiratory emergencies (MI, COPD, etc.) and then consider how his anatomy may be contributing to his symptoms.
• Sternal retractions in any patient (think infants) with severe respiratory distress and failure (and this patient if he was in worse condition or decompensates), should improve with positive pressure ventilation (preferably CPAP, or if critically ill consider BVM or intubation).

Suggested References

Shortness of Breath


• Gender: Male
• Age: N/A
• Height: N/A
• Weight: N/A


• Temperature: N/A
• Blood Pressure: N/A
• Heart Rate: 125
• Respiratory Rate: N/A
• Pulse Oximetry: 80% RA

Signs and Symptoms

Cough, shortness of breath < 24 hours; pt states cough is productive.


• S/P Myocardial Infarction 6 yrs ago

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