Cardiology Narrative
Cardiology PCR
S: Medic 1 dispatched to medical school library for unknown medical emergency. Upon arrival to scene
medic 1 crew was lead to third floor stacks where a 22 year old male was complaining of chest pain.
Patient was questioned about his chest pain and stated that “they began about 45 minutes ago while he
was studying for finals”. Patient also stated that “he was a first year medical student and wanted to do
well on his finals or else he would be placed on academic probation”. Patient admitted to being awake
for the past 36 hours and had been intaking “monster energy drinks” and caffeine pills with last oral
intake being last night at approximately 11:00pm. Patient denied any medical history or allergies as well
as emphatically denied any use of any other drugs. Patient later after administration of adenosine,
stated to medic 1 crew that he experienced a strange sensation after administration.
O: Initial impression and physical exam noted that patient appeared young and well nourished as well as
anxious and nervous. Patient was alert and oriented x3 unable to adequately answer event, airway was
open, breathing was normal rate and depth, radial pulse was strong and rapid. Skin was pink, warm and
diaphoretic. First vitals as follows, pulse strong and regular at 210, BP 112/74, RR 20, non-labored.,
SpO2 95% on room air. Cardiac monitoring was employed and showed narrow complex tachycardia at a
rate of 212. After administration of adenosine patient showed a transient decrease in heart rate at
165bpm then rapidly increased to 206bpm. Patients heart rate after second dose of adenosine was
210bpm, after administration of diltiazem rate decreased to 104 and other vitals as follows, skin pink,
warm, dry, Pulse 104, ECG shows normal sinus rhythm, BP 124/76, RR 18, non-labored, SpO2 99% at
4L/m via NC.
A: Patient is experiencing acute cardiac dysrhythmia of SVT. Patients lack of nourishment and sleep have
possibly imbalanced electrolytes.
P: While assessing patient vitals were obtained and noted mild hypoxia, a nasal cannula at 4lpm was
applied. Cardiac monitor showed narrow complex tachycardia and iv line access was obtained in right
forearm. Patient was asked to bear down with no change to rate or rhythm. After iv access was
established, adenosine at 6mg was administered followed by a 20-ml fluid bolus, short unsustained
change in heart rate. Initial dose of 6mg of adenosine proved unsuccessful, a second dose of 12mg of
adenosine was administered followed by 20ml fluid bolus. Second dose proved unsuccessful as well with
shortchanges and then back to 210bpm. After 2 minutes a third dose was administered and proved
unsuccessful. Patient state remained unchanged. Due to patient being in stable condition diltiazem was
administered at 25mg iv push. After approximately one minute patients vitals began to decrease with
cardiac monitor showing patients heart rate to be 104 and consistent. Patient report was than called
with nothing significant noted and patient state is as follows skin pink, warm, dry, Pulse is now
104bpm, ECG shows normal sinus rhythm, BP 124/76, RR 18 non-labored. SpO2 99% at 4L/m via NC.
Patient care transferred to ED nurse with no changes in patient condition and all belongings with
patient.