Serial Killers - Expand your pre-arrival differential diagnosis list.

Another topic covered on the MCHD Paramedic Podcast Episodes #79, 80, 81 & 82. Please support the MCHD Paramedic Podcast.

7/20/20212 min read

Serial Killers

The tones drop, and you and your partner are dispatched for a chief complaint of “…” In a perfect world, our patients would call 911 and tell the dispatcher that they are experiencing a case of Acute Pulmonary Edema. In the real world, we get a chief complaint of Shortness of Breath or Chest Pain. Patients communicate complaints and symptoms, not disease processes, pathophysiology, or causes, and it is our job as EMS providers to evaluate the patient’s overall presentation (complaints, signs and symptoms, physical exam, vital signs, assessment results, medical history, and medications) to formulate differential diagnosis and treatment and transportation plans. En route to the call, your differential diagnosis thought process should begin. While responding to the call, discussing the potential serial killers for each category of chief complaint with your partner will help to ensure that we are not missing the five most common killers in each category. While there are many, many more than five per category, these are the top five, most commonly encountered serial killers.

Keynotes and points for all categories: Vital signs are vital, all altered patients get a blood glucose, all patients get an ECG, 4-Lead at a minimum and a 12 or 18-Lead depending on the findings and interpretation, a patient doesn’t need to be hypotensive to have a shock index (a B/P of 100 with a heart rate of 120 is a shock index of 1.2, anything over 1.0 should increase your suspicions of a shock state), always consider the QSOFA score for patients with possible sepsis, 1 point each for 1.) respiratory rate >22 breaths/min, 2.) altered mental status 3.) systolic BP <= 100mmHg (MAP <60) a QSOFA score of 2 or 3 should cause a sepsis activation at the receiving facility.

Chest Pain Serial Killers:

  1. Acute Coronary Syndrome & Myocardial Infarction - AMI, STEMI, Non-STEMI & NOMI.

  2. Pulmonary Embolism

  3. Aortic Dissection

  4. Pneumothorax

  5. Cardiac Tamponade

Shortness of Breath Serial Killers:

  1. COPD & Asthma

  2. SCAPE - Symptomatic Crashing Acute Pulmonary Edema

  3. Infection, Pneumonia, SEPSIS

  4. Infarction - Pulmonary Embolism & ACS/AMI

  5. Non-Pulmonary Causes - Acidosis, DKA & Toxicity

Acute Abdominal Pain Serial Killers:

  1. Ruptured AAA

  2. Ruptured Ectopic Pregnancy

  3. Ischemia

  4. Perforation

  5. Torsion - Testicular & Ovary

Altered Mental Status Serial Killers:

  1. Stroke/CVA - Ischemic & Hemorrhagic

  2. Seizures - Postictal Phase

  3. Infections - Meningitis, Encephalitis & SEPSIS

  4. Endocrine - Hypoglycemia & DKA

  5. Toxins - Exposure & Intoxication

Trauma Serial Killers:

  1. Hemorrhage

  2. Obstructive Shock - Tension Pneumothorax & Tamponade

  3. Hypoxemia - C-Spine Injury “3, 4, 5 - Keep the diaphragm alive!”

  4. Closed Head Injury - TBI, ICP

  5. DIC - Delayed Killer, Disseminated Intravascular Coagulation

PLEASE ALWAYS REFER TO OUR PROTOCOLS AND TREAT ACCORDINGLY. THE FOLLOWING RESEARCH AND INFORMATION ARE PRESENTED AS INFORMATIONAL AND TO PROVOKE DEEPER, HIGHER-ORDER CLINICAL THINKING.