Acute onset, chest pain and shortness of breath


• Scene – vital signs, EKG, assessment, Hx from parents

• En route – 12 lead, IV, BG, assessment

• Hospital – unknown


• Response to treatment – using Wong Baker scale, pt looks to be at a two. We did not give any NTG or ASA. 12 lead showed NSR.

• Disposition – unknown


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


  • Chest pain of uncertain etiology
  • Koolen-de Vries syndrome
  • Asthma
  • Autism

Differential Diagnosis

• Myocardial infarction

• Chest contusion

• Psychogenic pain

• Arrhythmia


• Asthma exacerbation

Patient Workup History

• Patient states – pt would answer questions with a yes or two most of the time, but when asked where his pain was, he would point to chest. Not able to give a number on pain scale.

• Caregiver states – Mom was helping pt out of the shower when he suddenly grabbed his chest and became pale and appeared short of breath. Episode lasted about 3 minutes. Mom states that pt does not complain very often. He loves to talk about sports and is normally very happy.

Physical Exam

• No trauma noted, but pt did have slight redness on shoulders. We surmised that he may have turned the water temperature in his shower up too high, and possibly been burned.

• GCS – 15

• EKG – sinus

• CBG – 108

Editor’s Notes

When interviewing children with special health care needs, it is key to interview the caregiver/parent to obtain an accurate history and sense of baseline status. This patient seems conversant with the paramedic, which is reassuring, although the vital signs reveal tachycardia and hypertension. Children with Koolen-de-Vries syndrome could have cardiac abnormalities – this needs to be evaluated in the history.

-Dr. David Spiro

Suggested References

Koolen-de Vries syndrome



• Gender: Male

• Age: 14 years

• Height: Not Available

• Weight: Not Available


• Temperature: 98.4 F/36.9 C

• Blood Pressure: 130/91

• Heart Rate: 114

• Respiratory Rate: 20

• Pulse Oximetry: 98% RA

Signs and Symptoms

Chest pain; shortness of breath

History Medical

• PMH: Asthma, Autism, Koolen-de-Vries syndrome.

• Alleriges: Penicillin

• Dispatch info: Chest pain and difficulty breathing.


• Lives with parents and sibling Medications

• Singulair, albuterol

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