Acute onset, shortness of breath h/o congestive heart failure


• Scene – EKG, vitals, O2

• En route – Vitals, TT

• Hospital – unk


• Response to treatment – O2 sats improved

• Disposition – unknown


Elliot Williams, Paramedic Woodburn Ambulance


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


• Shortness of breath

Differential Diagnosis

• CHF – chronic vs. exacerbation

• COPD exacerbation (may explain dyspnea)

• Pericarditis

• Medication non-compliance

• Myocardial infarction

• Pneumonia

• Aortic aneurysm

• Musculoskeletal pain

• Arthritis

• Pulmonary embolus

• Pneumothorax

Patient Workup History

• Patient states – That she feels SOB she has to take a deep breath and then has to take another deep breath. Her feet have been swollen for about two weeks; she did not want to go to hospital, but was willing to let us do what we needed to.

• Caregiver states – Pt has a POLST/DNR form for comfort measures only and pt only wanted some oxygen today

Physical Exam

• Physical findings – Pedal edema, slightly diminished lung sounds

• EKG – SR

• CGS – 15

Editor’s Notes

Noted the pitting edema on exam. Understanding baseline exam findings such as pitting edema of the legs from the patient or facility may be helpful in determining etiology.

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


• Gender: Female

• Age: 84 years

• Height: Not Available

• Weight: Not Available


• Temperature: 98.6 F/ 37 C

• Blood Pressure: 172/54

• Heart Rate: 60

• Respiratory Rate: 16

• Pulse Oximetry: 92% RA

Signs and Symptoms

Shortness of breath

History Medical

• HTN, CVA, CHF, kidney disease

• Allergies: PCN, Oxycodone

• Dispatch info: Difficulty breathing


• Lives in a care facility Medications

• Lasix, levothyroxine, lisinopril, magnesium, metoprolol, Tylenol, Zetia

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