Case of the Month
Decmeber 2003

28-year-old female with syncopal episode

You and your partner are dispatched to a reported 28 Y.O. female who has had a single syncopal episode. You arrive to find the patient supine on the floor breathing rapidly, confused, pale with cold clammy skin. Her husband quickly reports she is normally very healthy and except for knee surgery last week for a torn ligament. She has never been hospitalized. She currently takes codeine as needed for pain and has no know medication allergies. Based upon the obvious “sick” appearance of patient you request a medic unit be dispatched to your incident.

As you begin your assessment of the patient, your partner obtains a pulse oximeter reading and administers high flow oxygen via a non rebreather mask: the baseline pulse oximetry reading is 84%. Initial vitals are BP 88/60, HR 140, and Resp 40. Her pupils and 4-5 mm and sluggish to light, her chest is symmetrical and lungs clear to auscultation.

Based upon these initial findings and history what do you suspect is the cause of the patient's condition?

Suspecting this patient may be suffering from a pulmonary embolism, you continue the high flow O2, monitor the her status and update the medic unit with a quick short report of your initial findings and ongoing treatment. Within a few minutes of beginning oxygen therapy you note an increase in the pulse oximetry reading to 94%. The patient’s vitals have also improved slightly: BP 98/70, HR 118, and RR 30. The patients LOC as also improved with the patient now alert enough to begin C/O SOB.

The medics arrive several minutes later, provide additional treatment and transport the patient to the local emergency department where test confirm your suspicion of a pulmonary embolism. The patient received a course clot dissolving medication and as since made a complete recovery.

Pulmonary embolism is a severe life-threatening condition in which normal blood flow thru the lungs is prevented by a blood clot. This obstruction prevents normal gas exchange (oxygen and carbon dioxide) resulting in severe hypoxia and leads to significant cardiovascular collapse and often death. Those at high risk for this condition include patients with: recent surgery, fracture, clotting disorder, obesity and immobility. Successful management of these patients depends on the EMT's ability to rapidly determine SICK vs. NOT SICK, request ALS, begin aggressive oxygen therapy and treat for shock.