Identifying Key Conditions

A patient presents with a chief complaint of chest pain, weakness, or nausea and vomiting. Upon assessment of their airway and breathing, they appear to be short of breath, and may be coughing up pink and frothy sputum. Upon assessment of their circulation, their pulse is irregular (either fast or slow), and their skin is pale, cool, and diaphoretic. Upon physical exam, you notice jugular vein distention in the neck and pedal edema in the feet OR rales in the lungs. Upon obtaining a patient history, they report a sudden onset of symptoms that are not provoked nor palliated by anything, including breathing. They express that they are experiencing pain that feels like pressure, tightness, or crushing. They express that the pain is sub-sternal, radiates to the left arm, jaw, or abdomen, and that this is their first time experiencing such symptoms. They report moderate to severe pain that has been going on for minutes to hours. Other symptoms they report include chest pain, weakness, and nausea and vomiting. Their past medical history may include hypertension, high cholesterol, diabetes, and/or obesity. Prior to this call, they did not undergo any significant exertion. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Acute myocardial infarction; assist the patient with nitroglycerin or aspirin

A patient presents with a chief complaint of chest pain. Upon obtaining a patient history, they report that the pain came on suddenly and is provoked by exertion but palliated by rest. They describe the pain as pressure, tightness, or squeezing. They report that the pain is sub-sternal and radiates to the left arm, jaw, or abdomen, and that this has happened to them before. They claim that the pain is mild to moderate and has been going on for about 5 minutes. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Angina pectoris/chest pain; assist the patient with nitroglycerin or aspirin

A patient presents with a chief complaint of chest or abdominal pain. Upon physical exam, you may notice a pulsating mass in the left abdomen and diminished pulses in the feet. Upon taking vitals, you may notice a blood pressure discrepancy between the two arms. Upon obtaining the patient’s history, they may report pain between the shoulder blades OR tearing abdominal pain that radiates anterior to posterior. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Aortic aneurysm, either thoracic or abdominal; transport the patient in the supine position

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you may notice rales in the lungs. Upon physical exam, you may notice jugular vein distention and dependent edema. Upon taking vitals, you may notice hypertension. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Congestive heart failure; no additional management needed unless indicated by other conditions

A patient presents with a chief complaint of chest pain. Upon assessment of their pulse, you notice it is weak. Upon physical exam, you notice jugular vein distention, muffled heart sounds, but equal breath sounds. Upon taking vitals, you notice hypotension, with narrowing pulse pressure upon reassessment. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Cardiac/pericardial tamponade; no additional management needed unless indicated by other conditions

A patient presents with a chief complaint of a sudden, severe headache or epistaxis. Upon assessment of their circulation, their pulse is strong and bounding, and their skin is warm (either dry or moist). They may present with an an altered level of consciousness, and report recent tinnitus and/or nausea and vomiting. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Hypertensive emergency; no additional management needed unless indicated by other conditions

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice they are wheezing, seated in the tripod position, and are using accessory muscles to breathe. Upon assessment of their circulation, you notice mild cyanosis. Upon taking vitals, you may notice hypotension. Upon obtaining a patient history, they report they were walking at the park in the middle of spring. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Asthma; assist the patient with a bronchodilator or epinephrine, whichever is prescribed to the patient for asthma

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, they appear short of breath and are wheezing. Upon assessment of their circulation, you notice their skin is flushed and that hives are beginning to form on the back of their neck. Upon taking vitals, you may notice hypotension. Upon taking a patient history, the patient reports that they were stung by a bee about 5 minutes ago. They also feel extremely itchy and slightly nauseous. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Anaphylaxis; administer epinephrine

How would you manage an insect sting? (5)

Scrape the object off the skin, wash the area with soap, remove jewelry, keep the bite site below the heart, and apply ice

A patient presents with a chief complaint of chest pain. Upon assessment of their airway and breathing, they appear short of breath with diminished breath sounds on one side. Upon taking a patient history, the patient reports that the pain gets worse whenever they breathe. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Pneumothorax; no additional management needed unless indicated by other conditions

A patient presents with a chief complaint of chest pain. Upon assessment of their airway and breathing, they appear short of breath and absent breath sounds on one side. Upon assessment of their circulation, their pulse is rapid and their skin is beginning to show signs of cyanosis. Upon physical exam, you notice unequal chest rise and fall, jugular vein distention, tracheal deviation, and crepitus upon palpation. Upon taking vitals, you may notice hypotension, with narrowing pulse pressure upon reassessment. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Tension pneumothorax; burp occlusive dressings

A patient presents with a chief complaint of chest pain. Upon assessment of their airway and breathing, they are breathing very quickly, and may be coughing up pink and frothy sputum. Upon assessment of their circulation, you notice that their pulse is rapid and that their skin is mildly cyanotic. Upon obtaining a patient history, the patient reports that the pain gets worse every time they breathe. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Pulmonary embolism; no additional management needed unless indicated by other conditions

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice rapid and shallow respirations that may be accompanied by pink and frothy sputum. You also notice rales in their lungs. Upon obtaining a patient history, the patient also reports feeling some chest pain, but that it does not get worse every time he breathes. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Pulmonary edema; administer a CPAP per local protocol

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice accessory muscle usage, a productive cough, difficulty when exhaling, pursed lip breathing, wheezing, and the patient sitting in the tripod position. Upon obtaining a patient history, you learn that they have been smoking for the past 20 years. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Chronic obstructive pulmonary disease (COPD), which includes asthma, emphysema, and chronic bronchitis; assist the patient with a bronchodilator

A patient presents with a chief complaint of shortness of breath. Upon assessing their airway and breathing, you notice stridor with each breath, as well as a barking seal cough. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed (2)?

Croup; ensure there is nothing in the patient’s mouth, and avoid suction and crying

A patient presents with a chief complaint of high fever for several days. Upon assessment of their airway and breathing, you notice they are sitting in the tripod position and are drooling excessively. The patient also reports having a sore throat for the past couple days. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed (2)?

Epiglottitis; ensure there is nothing in the patient’s mouth, and avoid suction and crying

A patient presents with a chief complaint of extreme anxiety. Upon assessment of their airway and breathing, you notice deep and rapid breathing. Upon physical exam, you notice spasms in their hands and feet. Upon obtaining a patient history, the patient reports that they have also been feeling very dizzy, and that their hands, feet, and lips are numb and tingling. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed (2)?

Hyperventilation; keep the patient calm and encourage them to slow their breathing

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice a productive cough (which may present with a whooping sound) and wet lung sounds. Upon obtaining a patient history, they also report chest pain that gets worse whenever they breathe, having a fever for the past few days, and recent nausea and vomiting. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Lower airway infections, including pneumonia, respiratory syncytial virus, bronchiolitis, pertussis/whooping cough, and tuberculosis; use additional BSI

A patient presents with a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice decreased breath sounds at the base of their lungs. Upon obtaining a patient history, the patient reports having congestive heart failure and being recently diagnosed with breast cancer. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Pleural effusion; no additional management needed unless indicated by other conditions

A patient was recently involved in a car accident and has a chief complaint of shortness of breath. Upon assessment of their circulation, you notice cyanosis in their face and neck. Upon physical exam, you notice jugular vein distention and hemorrhage in the sclera. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Traumatic asphyxia; no additional management needed unless indicated by other conditions

A patient was recent involved in a car accident and has a chief complaint of shortness of breath. Upon assessment of their airway and breathing, you notice rapid, shallow respirations. What condition is this patient likely presenting with, and in addition to calling ALS, supporting the ABCs, and completing the rest of your assessment, how should this condition be managed?

Pulmonary contusion; no additional management needed unless indicated by other conditions