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You are responded to a shortness of breath. The patient is a 26-year-old female. Her husband told Control that "it looks like my wife is dying!".
The patient gave birth to her second child about 20 minutes ago but since become very unwell. Delivery was normal and placenta has passed. There's about 250 ml of post-partum blood on a towel but all vaginal bleeding has arrested.
It does indeed look like she is making a concentrated effort to die. She responds to voice, is very pale, skin is mottled and sweaty, she gasps for breath and has had a big vomit on the floor. The vomit has chunky bits and is very frothy and watery looking.
Obs: BP 80/50, PR 120, RR 30, Temp 36.5°, SpO2 82% RA, BGL 7 mmol/l, ECG sinus tachycardia.
O/E the only significant finding is when you listen to her chest; you hear bilateral sounds are some combination of wheezes and crackles.
1. Succinctly describe her primary problem? ("she is dying" is obvious and not acceptable!)
2. Putting lung sounds aside, what does the pattern look like? Is it consistent with the history?
3. What treatment do you provide?
4. You're 20 minutes from a secondary hospital and 50 minutes to a tertiary hospital. Where do you go?
5. HEMS at the tertiary hospital can come out and back you up. They have blood and ultrasound. Do you call for them? Do you want them to come by road or air? What do you do in the meantime?
The patient gave birth to her second child about 20 minutes ago but since become very unwell. Delivery was normal and placenta has passed. There's about 250 ml of post-partum blood on a towel but all vaginal bleeding has arrested.
It does indeed look like she is making a concentrated effort to die. She responds to voice, is very pale, skin is mottled and sweaty, she gasps for breath and has had a big vomit on the floor. The vomit has chunky bits and is very frothy and watery looking.
Obs: BP 80/50, PR 120, RR 30, Temp 36.5°, SpO2 82% RA, BGL 7 mmol/l, ECG sinus tachycardia.
O/E the only significant finding is when you listen to her chest; you hear bilateral sounds are some combination of wheezes and crackles.
1. Succinctly describe her primary problem? ("she is dying" is obvious and not acceptable!)
2. Putting lung sounds aside, what does the pattern look like? Is it consistent with the history?
3. What treatment do you provide?
4. You're 20 minutes from a secondary hospital and 50 minutes to a tertiary hospital. Where do you go?
5. HEMS at the tertiary hospital can come out and back you up. They have blood and ultrasound. Do you call for them? Do you want them to come by road or air? What do you do in the meantime?