Real life senerio for you! Its a fairly easy one....

[usafmedic45]

USAFmedic45, when I read your reference to the goth through the plate glass window, I laughed so hard I started snorting. In the school library. People are looking at me like I have a penis on my forehead. Thanks

Glad to be of service.

 

[HappyParamedicRN]

I had a transfer patient a few months ago with the biggest PE anyone could remember seeing in a living patient. Saddle PE with extension into the heart and all the way down to the distal vasculature in the lungs. His CC was SOB, more specifically dyspnea on exertion, with RA SpO2 in this 80s. 95-96% on 8lpm. I remember the CO2 was low, but not anything too crazy, 20s I think.

He had no chest pain, BP was fine. Mentation was fine. He had increasing dyspnea on exertion over a month, and finally got it checked out when the SOB didn't go away with rest.

Oh hey immagine that a low o2 sat...hmm go figure.. oh wait patirnts with PEs dont get low o2 sats just ask the expert respiratory therapis that knows it all!

 

[usafmedic45]

oh wait patirnts with PEs dont get low o2 sats just ask the expert respiratory therapis that knows it all!

Two things: 1. I don't know it all. What I do know is where the limits of my knowledge lay and that is far more important. It's better to know some of the questions to ask than to try to have all of the answers.
2. I never said that they don't have low sats. I said they don't always present with cyanosis. You do understand the difference between O2 saturation and O2 content right? You also understand that hypoxemia and cyanosis are not the same thing, correct? The latter is a symptom of the former, a symptom that is not always present and is not present in most patients until you get significant amounts of deoxygenated hemoglobin present (usually about 20-30% of the circulating hemoglobin level; it can be much, much higher in certain genetic conditions and in persons with dark or ruddy complexions). Also the case you presented didn't have a reading prior to being placed on high flow O2 so we are unlikely to know if there was hypoxia or not.

It's a moot point to argue since we don't know that information. I'm also guessing that this scenario is pretty much done with since every time we question you or point out a misconception you are attempting to further, you get defensive and hateful. Have a nice night.

 

[Aidey]

My patient was not cyanotic, but he was significantly anemic, and to quote "pale as an overeager goth hemophiliac who went neck first through a plate glass window".

She had cold septic shock. Can we be done with this "scenario" now? Congrats to you for figuring it out on scene. Maybe one of us could have if this had actually been presented as a scenario.

 

[Handsome Robb]

Why is it that educational threads always turn to arguments on this forum? There are people around who have less education who are interested in learning...

I would never have even considered septic shock from what was presented... Would someone like to explain what lead to this dx for me? I'd love to know.

 

[Anjel]

Why is it that educational threads always turn to arguments on this forum? There are people around who have less education who are interested in learning...

I would never have even considered septic shock from what was presented... Would someone like to explain what lead to this dx for me? I'd love to know.

Can we just find out what was actually wrong. Then continue on with whatever you guys wanna argue.

 

[Aidey]

I know it was sepsis because I read a post that has since been deleted.

Just based on the information presented here, you couldn't determine it was septic shock for sure, as there are several other possibilities. Given what we do know, it is most likely she is in some sort of shock, it is just a matter of figuring out which one based on history and assessment.

Knowing now that it is septic shock, I can look at my quick and easy sepsis check list and see what she meets. We don't really know if she has a known or suspected infection without more history from the son. We don't know a temp, but her her respirations are over 20, Co2 under 32, and she has an AMS. That means she meets the required 2 criteria for suspected sepsis/SIRS.

 

[Aidey]

Can we just find out what was actually wrong. Then continue on with whatever you guys wanna argue.

Cold septic shock per the OP.

 

[Anjel]

Cold septic shock per the OP.

oh sorry must have missed that.

 

[usalsfyre]

That means she meets the required 2 criteria for suspected sepsis/SIRS.

Agreed, but pretty much any patient with any sort of mid-to-high level pathology meets SIRS criteria, so that's only of limited diagnostic value.

 

[Aidey]

I know, but if we had more details she would likely meet more making it slightly more helpful.

 

[usalsfyre]

I know, but if we had more details she would likely meet more making it slightly more helpful.

Gotcha