Public Safety Training Facility

Monroe Community College
Rochester, New York

MCC Paramedic Program Case of the Month 4/98

Dispatch Info: 6:30 pm, Nature: female, short of breath

You Find a 65 yo w female who complains of SOB for several days but it has been severe the last few hours. The only history that the patient has is a rare blood disorder called MDS (Myelodysplastic Syndrome). She says that she receives blood transfusions 1-2 units every 2 weeks. She has a scheduled transfustion tomorrow. Her only medication is ASA 325 mg. qd. for a "high platelet count". She has never had heart problems or respiratory problems. She was a smoker but quit 20 years ago.

Physical exam: female patient, appearence consistent with stated age, is found supine on a couch, conscious, .

VS: Pulse 120, Resp 22, BP 100/70, Temp 37.0

ROS: LOC-Cx, Alert, oriented x3. HEENT-Head:NCAT,Eyes:=@3 mm, conjugate. Very pale palpabral conjunctiva. Neck-no JVD Ears:WNL. Nose:WNL. Throat:WNL. CHEST-Clear to auscultation bilaterally. No retractions of the neck or chest. No scars or injuries observed. COR-regular, S1S2 well heard no R/M/G heard. ABD-soft, not distended. EXTREM-equal pulses, no edema. Extreme finger extention shows abnormal (absent) crease response (see photo), DTR's equal and about +2. SKIN: warm, dry, pale.

Note the color in the lines of the hand upon hyperextension

press here to see normal

On scene Labs: Blood Oxygen saturation on room air: 99%. Blood Glucose 110 mg / deciliter. 12 Lead ECG: Sinus Rhythm, QRS axis of 60, QRSI: 0.10, PRI: 0.14, T's slightly inverted in inferior leads, ST segments Isoelectric in all leads.

Based on the history, physical exam, and lab tests you should consider: (there may be several correct differentials)

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* Congestive Heart Failure

* New onset COPD

* Severe anemia

* Pneumonia

* Hyperventilation Syndrome

* Pulmonary Embolism

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Updated: April 1, 1998