Medic 26 responds to a local Extended Care Facility (Nursing Home) for a female in her 60s complaining of chest pain.
This is fairly standard run for my service, we have many contracts with the nursing homes in the area. I probably make two chest pain complaints a shift. They can be everything from the hypochondriac to an actual heart attack.
Today is no different. The patient is complaining of chest pain, the facility have administered nitro three times with no relief. I ask the standard littany of questions, in no particular order:
Where does it hurt?
How long have you had this pain?
Does it go (radiate) anywhere?
Have you done anything that makes it hurt more?
Have you done anything that makes it hurt less?
Does it hurt more when you breathe in or out?
On a scale of 0-10, 0 being no pain, 10 being the worst pain you’ve ever felt how would you rate your pain?
I have the benefit of written medical history, MARs and the patient to gain all of the requeset information that would be pertinent to my assessment. The patient replies with standerdized answers, it has been hurting all day, pain is an 8, the pain is here (pointing to her sternum), nothing makes it better or worse and it doesn’t hurt more when I breathe. The patient was recently released from the hospital for hip replacement.
I start my physical assesment, take vitals and hook up the lifepak 12. Everything looks fairly normal. Establish IV, no nitro since it hasn’t worked yet (and I’m not convinced this is cardiac related). On the way to the elevators the nurse says that the patient has a few broken ribs. My biggest mistake was not inquiring further, but I suspect this could be part of our problem.
The hospital is less than 2 miles, the patient is in no distress, easy non emergent transport. I put the patient on oxygen 2 liters via nasal canula just for protocol sake.
I give the triage nurse my report, all vital signs normal. The patient’s husband meets us at the hospital. Enter the great epiphany. Mr. Husband informs the triage nurse that the patient “coded” in the hospital last week and the broke some ribs performing CPR. You would think that someone would have mentioned to me this MINOR detail. With all the pieces of the puzzle now on the table, this is a no brainer. Yes, your chest hurts because you have broken ribs. Why the heck did the nursing home administer nitro for this chest pain?
The triage nurse and I agreed that the chest pain (which I did notice hurt more when we moved her to the stretcher) was most likely from the fractured ribs.
Please engage your brain before blindly following protocol.
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