Public Safety Training Facility

Monroe Community College
Rochester, New York

MCC Paramedic Program Case of the Month 03/99

EKG Tracing

Chief Complaint:

The patient is an 82yo female found in the care of BLS. Her VS are: P-48 and irreg., BP- 102/80, Resp-18 and normal Skin color- pink, Pulse Saturation 98% on room air. The daughter called the ambulance because the patient is becoming more fatigued and short of breath each day. Three weeks ago the patient had cardiac surgery that included CABG of three vessels and an aortic valve replacement with a porcine valve. She has no allergies and takes the following medications: Lasix 20 mg qd, Colace 50 mg prn, Nitrostat 0.4 mg prn pain, Lanoxin 0.125 mg qd, Coumadin 4 mg qd, Atenolol 100 mg qd. At the current time she is asymptomatic, found sitting in a wheelchair in the living room of the house.

Physical Exam:

After moving her suitcase and removing her coat : ) .........The patient is a well developed well nurished 82 year old woman who is alert to person place and time. She feels fine while sitting still but says she becomes very short of breath when she tries to do anything at all. HEENT: Eyes- equal at 4 mm, Neck- supple, no JVD CHEST: Lungs sound clear to auscultation bilaterally. Cor- S1 S2 well heard, irregular, no R/M/G. ABD: Soft, non-tender. EXTREM: MAE well, = strong pulses, no edema. 12 Lead unremarkable save for the irregular slow rate.

Additional History:

The patient sleeps well, flat on one pillow. She has no N/V/D. She denies: fever, chills, or chest discomfort. Her bowel and bladder habits are unchanged and is negative for melena. She has been eating and drinking normally.

Based on the available data, Choose the correct items: (there are 3 correct answers)

(press the blue button)

This patient is stable and can safely be transported by the BLS crew alone

This patient may have excessive cardiac slowing due to several medications

This is classic GI bleeding presentation

This patient might have SSS but will require reduction of rate supressive meds before that can be determined

Orthostatic Vital Signs may be of some diagnostic value

ECG Beats 3 and 10 could be described as premature junctional contractions

This is likely to be heart failure or aortic valve dysfunction

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Updated: March 10, 1999