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Clinical scenario: Patient with chest pain

You are dispatched to a report of a male patient with chest pain


Do you think that Brian is having a cardiac event?

Photo/Michigan Department of Health and Human Services

Rescue 1761, Medic 4, respond priority one to Central Park downtown. Your patient will be located at the gazebo on the southeast corner. The caller reports that the patient is having chest pain which started while running.

You arrive on scene and are waved over to the gazebo, where several bystanders are attending to a male patient you estimate to be in his 50s. The patient appears alert but is obviously experiencing discomfort. When you introduce yourself, the patient responds in full sentences and appears to be breathing without difficulty. The patient’s name is Brian.

Brian explains that he is a city employee and was standing on a ladder, hanging decorations on the gazebo when he experienced a sudden onset of left-side chest pain. He has never experienced pain like this previously.

Brian has a history of hypertension and takes a beta blocker, but cannot recall the name. He also has a family history of heart disease and an allergy to penicillin.

As your partner sets up the monitor for a 12-lead ECG, you perform a focused secondary exam. You find that Brian’s pain increases with palpation, but you do not note any obvious trauma to his chest. Brian states that the pain also increases when taking a deep breath and he has clear lung sounds in all fields. Your partner completes the 12-lead ECG and states that the rhythm is normal.

Brian’s vital signs are:

  • BP: 148/110
  • HR: 58
  • RR: 14
  • SpO2: 99% RA

What are the next steps in your assessment? Consider the following questions:

  • Do you think that Brian is having a cardiac event?
  • If so, why?
  • If not, what are some causes of his symptoms?

Post your answers in the comments and view the solution for this scenario.

An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.