Shortness of Breath, “Chest Pressure”


• Scene – IV 20G, 12 lead, O2, NTG, CBG

• En route – VS EKG

• Hospital – n/a


• Response to treatment – relieved some but not all pain

• Disposition – Unknown


Elliot Williams, Paramedic Woodburn Ambulance


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


• Cough
• Shortness of breath

Differential Diagnosis

• Pneumonia

• Myocardial Infarction

• Congestive heart failure exacerbation

• Pulmonary edema

• Pulmonary embolus

• COPD exacerbation

Patient Workup History

• Patient states – Has had cough for 2 days and chest hurts with breathing (pleuritic pain), which makes her cough.

Physical Exam

• Pain with inspiration

• Productive cough, mostly clear.

• Pedal edema

• GCS – 15

• EKG – Afib

• CBG – 96

Editor’s Notes

The routine work of a paramedic involves continuous multi-tasking. Notice how the paramedics work as a team, while engaging the patient, while moving forward in their progression of assessment and treatment of the chief complaint.

-Dr. David Spiro


• Gender: Female

• Age: 83 years

• Height: Not Available Vitals

• Temperature: 97.4 F/36.3 C

• Blood Pressure: 121/75

• Heart Rate: 106

• Respiratory Rate: 18

• Pulse Oximetry: 95% RA

Signs and Symptoms

Shortness of breath; cough; chest pressure

History Medical

• PMH: Hypertension; renal disease.

• Allergies: Lasix; sulfa

• Dispatch info: Shortness of breath; cough; chest pressure.


• Lives alone but has network of friends.

• Moving to assisted living facility in near future.


• Coumadin; nitroglycerin

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