# Transport I had today



## marcus2011 (Jun 13, 2011)

Aight so we picked up a 84 year old female with terminal cancer to transport her to her doctors office. Her vitals at the time were

Bp: 72/50( this was acquired by the doctor, no one on our truck could even hear any sounds while trying to get bp, doctor had to use an amplifier)
Pulse 122
Resp. Rate 28 very shallow
O2 sat was 91
Cap refill 3 seconds
very lethargic


She was also shaking very bad and this was not normal for her. We took her to her doctor and they immediately got a DNR order.

Im thinking at this point in time she was in decompensation  shock. Anybody else got any ideas?


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## JPINFV (Jun 13, 2011)

I think she's 84 year old with terminal cancer who was probably on palliative care before, and if they got the DNR at the office, definitely afterwards. Rule number 1 is people die, and sometimes the best thing to do is not argue or fight with rule number 1.


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## marcus2011 (Jun 13, 2011)

true but Looking at her vitals it seems to me like she is in decompensated shock thats what im wondering


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## usalsfyre (Jun 13, 2011)

She's certainly decompensating, but....saying someone's on decompensated shock is clinically about as useful as saying someone died from cardiac arrest. Without a root cause of the hypoperfusion, you can't really start treating it appropriately.


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## marcus2011 (Jun 13, 2011)

just making sure I was going along the right route with the decompensation thanks bud


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## Aidey (Jun 13, 2011)

She has terminal cancer, what else would she be doing but decompensating?


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## MrBrown (Jun 13, 2011)

The low BP, tachycardia and tachypnea are signs of shock .... as well as four hundred different things.

They are broadly specific to somebody who is hypoperfused however are not highly specific to a particular aetiology.  

Brown would be more concerned with this patients GCS, mental state, past history and trend.

Was this an acute job or was it a pre-arranged Nana-taxi?


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## usalsfyre (Jun 13, 2011)

Aidey said:


> She has terminal cancer, what else would she be doing but decompensating?



There's terminal cancer, and there's end-stage cancer. There's lots of folks walking around with essentially terminal cancer, it just hasn't gotten to the point of completely impairing biological function.


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## marcus2011 (Jun 13, 2011)

MrBrown said:


> The low BP, tachycardia and tachypnea are signs of shock .... as well as four hundred different things.
> 
> They are broadly specific to somebody who is hypoperfused however are not highly specific to a particular aetiology.
> 
> ...



This was a pre-arranged transport and the nurse was real quick with wanting us to leave with her


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## medicdan (Jun 13, 2011)

At that point you really need to focus on comfort measures. Perhaps she would feel better with some IV fluid, anti-emetics or pain relief. Beyond that, you're not going to treat much.


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## JPINFV (Jun 13, 2011)

usalsfyre said:


> There's terminal cancer, and there's end-stage cancer. There's lots of folks walking around with essentially terminal cancer, it just hasn't gotten to the point of completely impairing biological function.



True... but all end-stage cancer is terminal cancer.


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## usalsfyre (Jun 13, 2011)

JPINFV said:


> True... but all end-stage cancer is terminal cancer.



True, but not all patients with terminal cancer are acutely decompensating (i.e. end-stage). 

I think we can declare the water sufficiently muddy now .


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## Aidey (Jun 13, 2011)

usalsfyre said:


> True, but not all patients with terminal cancer are acutely decompensating (i.e. end-stage).
> 
> I think we can declare the water sufficiently muddy now .



Nah, we haven't even discussed stage 4 cancer yet.


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## JPINFV (Jun 13, 2011)

usalsfyre said:


> True, but not all patients with terminal cancer are acutely decompensating (i.e. end-stage).
> 
> I think we can declare the water sufficiently muddy now .




EMT IQ test?

If all of A are B, and some of B are C, then...


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