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Next scenario - 1/29/2000

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Well, since the last one wasn't a challenge (congratulations to the many who

immediately got it) I'll propose the next one:

A 70 year old male arrives at the EMS station in a pickup with his son

driving. It is a hot summer day with high humidity. He states that he was

trying to chase a cow back into the pasture when he suddenly became very weak

and short of breath and had to sit down to rest. After a few minutes he

felt well enough to get into the truck. His son insisted on bringing him to

the EMS station against his wishes. He related no previous significant

illnesses but was a 100+ pack/year smoker and overweight. I observed him to

be pale and diaphoretic. He denied any pain and said that he didn't want us

to do anything: he just needed to go home, get under the air conditioner and

cool off. While I was talking to him he vomited.

How would you deal with this patient? Assume he consents to examination.

Be specific in terms of history questions asked and what kind of physical

exam you would do and what your immediate management would be. Assume that

you have a LifePak 10 and are paramedic certified with an EMT as your

partner.

Gene Gandy, JD, LP

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