# Basic Life Support - Question of the Day - Medic 27 (#3)



## Medic27 (Aug 18, 2017)

M27 respond 112 Oceanside Dr. with a chief complaint of difficulty breathing subject advises he is on supplemental portal oxygen.[4:07 AM]

You arrive on scene to find a 47 year old male in the tripod position, you approach him and notice he is conscious but only notices you as you call out to him.[4:15 AM]

Vitals

HR- 59
BP - 112/74
O2 Sat: 90% w/ his supplemental oxygen
GC: 81mg/DL

Rhonchi can be heard throughout all breathing fields. Patient also notes he has a history of smoking, but says he doesn't anymore but it's evident he is lying. Ash trays and cigarettes help you make this assumption. You ask him if he has any prior medical conditions, but he claims he doesn't know. Skin color is pale but he says that's normal, you also notice he has yellow fingernails. (for basics, what does this indicate?)

Primary symtoms: cough, fatigue, septum, fever, chills, chest congestion, throat flem varying in color.

What is this patient suffering from?
What can you do for this patient at an on scene level of treatment?

Subject refuses to be taken to the hospital, but he says you are okay to "make him feel better" (says every other EMS patient ever).. He will not go to the hospital, he is oriented 3/4

Knows where is.
Knows his name.
Knows who we are.
Says Ronald Reagan should be president but he doesn't follow that political bull**** now.[4:31 AM]

What can we do or say to treat this patient?


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## OREMT (Aug 18, 2017)

Basic here.

I'd like to know more about his chief complaint. What's the rate, rhythm and quality of his breathing? Can he speak in full sentences? Does he purse his lips when exhaling?

Onset of symptoms?
What's his temperature?
Does he take any meds?

With any difficulty breathing id also like to get him on the monitor/acquire a 12 lead. 

And the yellow fingernails are, I believe, from smoking.


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## Medic27 (Aug 18, 2017)

OREMT said:


> Basic here.
> 
> I'd like to know more about his chief complaint. What's the rate, rhythm and quality of his breathing? Can he speak in full sentences? Does he purse his lips when exhaling?
> 
> ...


Chief complaint is difficulty breathing, he can speak partial sentences but has to stop to catch his breath. He does purse his lips when exhaling, onset of symptoms were when he was sitting on his porch. Temperature is 100, he does not take any meds other than his portable oxygen. 12 lead shows - sinus rhythm, no apparent heart distress. Yellow is from lack of oxygen being able to reach extremities due to damage from smoking, you are correct. I'd also like to add his respiratory rate is 11.


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## EpiEMS (Aug 18, 2017)

From me, he's getting an NRB, if he'll accept it, or even better, perhaps CPAP.


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## Medic27 (Aug 18, 2017)

EpiEMS said:


> From me, he's getting an NRB, if he'll accept it, or even better, perhaps CPAP.


Gotcha, if you could convince him to go to the ED and you were calling ahead. What is his condition?


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## EpiEMS (Aug 18, 2017)

Medic27 said:


> Gotcha, if you could convince him to go to the ED and you were calling ahead. What is his condition?



Given the presentation (increased respiratory distress in a patient likely with COPD), I'm thinking: COPD exacerbation or pneumonia

I'm also considering pleural effusion, pulmonary embolism (is he hypercoagulable? is he fairly static?), and ACS (not entirely consistent with the presentation, but he is high risk).

I'm a little surprised at the low-ish heart rate given his dyspnea. Is he on any meds other than home O2? Is he compliant with his meds?


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## Medic27 (Aug 18, 2017)

EpiEMS said:


> Given the presentation (increased respiratory distress in a patient likely with COPD), I'm thinking: COPD exacerbation or pneumonia
> 
> I'm also considering pleural effusion, pulmonary embolism (is he hypercoagulable? is he fairly static?), and ACS (not entirely consistent with the presentation, but he is high risk).
> 
> I'm a little surprised at the low-ish heart rate given his dyspnea. Is he on any meds other than home O2? Is he compliant with his meds?


No other medications tbh I am not familiar with enough, but yes the answer was COPD and ultimately headed towards respiratory failure at some point. Progressively continuing to smoke given the scene appearance, and that he happened to be on the porch when it happened. Well done, great job.


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## EpiEMS (Aug 18, 2017)

@Medic27, this is the kind of patient where - if they don't want to be transported - I would like to try and get medical control to convince them (if I can't get an ALS provider on scene to try).


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## Medic27 (Aug 18, 2017)

EpiEMS said:


> @Medic27, this is the kind of patient where - if they don't want to be transported - I would like to try and get medical control to convince them (if I can't get an ALS provider on scene to try).


Great recommendation, I personally forgot about getting med control to talk to them.


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