EMS is called to a local urgent care center for a 55 year old male with chest pain.
On arrival, a patient care technician states that the patient is experiencing a hypertensive crisis.
He has already received SL NTG x3 but his BP is still 180/118.
The physician states that he is also worried about changes on the patient’s ECG and he has “already talked to the ED physician”.
The patient is placed on the gurney and he is removed to the back of the ambulance.
He appears to be in no distress.
In fact, he denies having chest pain. He states, “I came in for a sinus infection but I started coughing and when I coughed I grabbed my chest so the doctor thought I was having chest pain.”
The paramedic says, “So you’re not having any chest pain at all?”
The patient answers, “Well, I had some pain in the right side of my chest last night and also along the inside of my right arm, but it went away. But that’s not why I came to see the doctor today.”
Past medical history: HTN
Meds: Lisinopril, Diovan HCT
Vital signs are assessed.
- RR: 18
- Pulse: 80
- NIBP: 188/120
- SpO2: 100 on RA
Skin is pink, warm, and dry.
Breath sounds are clear bilaterally.
The cardiac monitor is attached.
A 12-lead ECG is captured.
Much ado about nothing?
Or a very astute urgent care physician?