# EMTLife Vitals Hall of Fame



## JPINFV (Aug 15, 2012)

What's the highest vital or lab values you've seen?

I once had a CCT where the patient walked into the ED with a BGL of 1500.

Recently admitted a patient with a BNP of 66,000.


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## Tigger (Aug 15, 2012)

Maybe not quite a lab value but I did a psych hold for a man that ingested 176 pills in a suicide attempt.


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## Achilles (Aug 15, 2012)

Had a PT come in back when I did clinicals with a BP of 245/120

Also had a Psych pt that had two fetaynol patches on his back and tried to eat one


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## saskvolunteer (Aug 15, 2012)

Had a DKA patient come in via EMS into ER. Unresponsive. pH was 39.7. Intubated and ICU bound.


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## usalsfyre (Aug 15, 2012)

Achilles said:


> Had a PT come in back when I did clinicals with a BP of 245/120
> 
> Also had a Psych pt that had two fetaynol patches on his back and tried to eat one



300/220 secondary to cocaine overdose.

BGL of 1860.

Troponin of 106 (yes 106 not 1.06)

K+ 8.6, hemodialysis pt wondering why she had to go to the ED

ETCO2 of 126 (never did find out what the gas was), end stage CF patient who was "a little more drowsy than normal".


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## JPINFV (Aug 15, 2012)

saskvolunteer said:


> Had a DKA patient come in via EMS into ER. Unresponsive. pH was 39.7. Intubated and ICU bound.




3.97 maybe? I hope someone repeated that ABG because it seems too low to be compatible with life. That's about the same pH as tomato juice, and normal is 7.35 to 7.45.


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## usalsfyre (Aug 15, 2012)

JPINFV said:


> 3.97 maybe? I hope someone repeated that ABG because it seems too low to be compatible with life. That's about the same pH as tomato juice, and normal is 7.35 to 7.45.



Yeah, the lowest I've heard of that still had a pulse (for a short time anyway) was 6.8 something.


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## Anjel (Aug 15, 2012)

Bp  264/126
Blood glucose of "high" which was 1200in the ER.
Blood alcohol .40


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## d0nk3yk0n9 (Aug 15, 2012)

One of my friends (not a patient) once blew a BAC of .48. Thankfully I wasn't there that night.


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## Aidey (Aug 15, 2012)

Blood glucose of 1707mg/dl - Sepsis patient with MODS, no hx of diabetes. 

K+ of 9.2 - ESRD patient who was on the fence about dialysis. Had been running in the 7-8 range for the previous month or two. 

EtCO2 of 7 - Conscious, alert, DKA patient.


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## bigbaldguy (Aug 15, 2012)

Umm I had a patient who was really out of breath once


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## EpiEMS (Aug 15, 2012)

Tigger said:


> Maybe not quite a lab value but I did a psych hold for a man that ingested 176 pills in a suicide attempt.



Beat my pt's record (120 1mg tabs of clonazepam)...dang!


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## Dwindlin (Aug 15, 2012)

Acute HIV Syndrome Patient:

Hbg: 3 g/dL
WBC: 1 cell/mL (no, not 1000)
Plt: 0

Talking to us in ED, died shortly after making it to the unit.


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## FLdoc2011 (Aug 15, 2012)

Routinely see blood alcohol levels in 400-500's.  

Acute pancreatitis patient with triglycerides >5000.

Pt with leukostasis and blast crisis with WBCs over 90,000.


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## adamjh3 (Aug 15, 2012)

Just this past weekend I got a SL temperature of "Hi" on a thermometer that reads up to 106*F


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## saskvolunteer (Aug 15, 2012)

JPINFV said:


> 3.97 maybe? I hope someone repeated that ABG because it seems too low to be compatible with life. That's about the same pH as tomato juice, and normal is 7.35 to 7.45.



Nope. I'm quite positive it was 39.7. None of us had ever seen. ABG was repeated by the RTs twice. He died shortly after.


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## STXmedic (Aug 15, 2012)

saskvolunteer said:


> Nope. I'm quite positive it was 39.7. None of us had ever seen. ABG was repeated by the RTs twice. He died shortly after.



That's not possible. pH is measured on a scale of 0 to 14. It does not go higher than that.


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## Aidey (Aug 15, 2012)

Hang on a second, I thought the pH scale only went from 1-14?


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## Epi-do (Aug 15, 2012)

Had a pt with a head injury that we couldn't get a BP on, because even taking the cuff up to 300, you immediately heard the beats as soon as you started deflating the cuff.  The ER thought we were full of crap when we told them his pressure was 300+ systolic, until they did it themselves and got the same results.


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## bahnrokt (Aug 15, 2012)

Tigger said:


> Maybe not quite a lab value but I did a psych hold for a man that ingested 176 pills in a suicide attempt.



I've got that beat if your willing to count the pills he fished out of the porto potty and shoved into his anal cavity. 

Was at a 3 day concert and security had been tossing confiscated drugs into the porto potty thinking nobody would ever be tempted to do mystery pills out of a public toilet.  They were wrong.


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## JPINFV (Aug 15, 2012)

Aidey said:


> Hang on a second, I thought the pH scale only went from 1-14?



It can go above 14 or below 1, but it's rare and pretty hard to do.


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## fast65 (Aug 16, 2012)

Well, I don't have anything nearly as impressive as you guys, but the only thing that's really popping out at me right now is a patient I transported with a pH of 6.82.


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## hoop762 (Aug 16, 2012)

BP 306/194

The moral of the story is people who skip out on a weeks worth of dialysis should no smoke crack.


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## firetender (Aug 16, 2012)

In my paramedic clinicals I had a pt. spiking 250 BP+, I was ordered to start an I.V. and when I removed the needle, pulsations of blood squirted out about ten feet!

...and I swear I hit a vein!


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## Meursault (Aug 16, 2012)

Somebody should be able to beat an INR of 14.9.
A woman I transported _back_ to a SNF for a short-term stay after a big teaching ED looked at her and said, "Not a hospital problem. Here's some Vitamin K and stay away from sharp objects."

On warfarin, no other contributing problems as far as I know.


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## bigbaldguy (Aug 16, 2012)

bahnrokt said:


> I've got that beat if your willing to count the pills he fished out of the porto potty and shoved into his anal cavity.
> 
> Was at a 3 day concert and security had been tossing confiscated drugs into the porto potty thinking nobody would ever be tempted to do mystery pills out of a public toilet.  They were wrong.



Wow! That is nasty.


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## abckidsmom (Aug 16, 2012)

My best that I can remember is a K of 10.2. A very end stage gastric bypass. 

Lowest measured bp in a live person 28/14. That hour took a lot of writing down vital signs.


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## medicsb (Aug 16, 2012)

INR of 21.


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## MSDeltaFlt (Aug 16, 2012)

CKMB of 25,000 on one MI pt. Died

A troponin of 400 on another one. Died.

A K of 13 that got better and went died. 

A heat stroke of 107F.

Maternal grandfather died from met CA when temp was 109.

Saw a radial artery pump but unable to feel the pulse... any pulse.  Odd.


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## citizensoldierny (Aug 16, 2012)

bahnrokt said:


> I've got that beat if your willing to count the pills he fished out of the porto potty and shoved into his anal cavity.
> 
> Was at a 3 day concert and security had been tossing confiscated drugs into the porto potty thinking nobody would ever be tempted to do mystery pills out of a public toilet.  They were wrong.





Guess the guy must have been a fan of Trainspotting, threw up a little in my mouth BTW.


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## Undaedalus (Aug 16, 2012)

saskvolunteer said:


> Nope. I'm quite positive it was 39.7. None of us had ever seen. ABG was repeated by the RTs twice. He died shortly after.



Sorry man, but there's no way. If this guy was a DKA PT, then he should have an acidic pH, whereas what you're describing would be blood somewhere on the order of 4x as alkaline as NaOH, read simply, wildly incompatable with life.


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## mycrofft (Aug 16, 2012)

bahnrokt said:


> I've got that beat if your willing to count the pills he fished out of the porto potty and shoved into his anal cavity.
> 
> Was at a 3 day concert and security had been tossing confiscated drugs into the porto potty thinking nobody would ever be tempted to do mystery pills out of a public toilet.  They were wrong.



Oh, golly...........:wacko:


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## mycrofft (Aug 16, 2012)

Not a lab value per se, but had a diabetic pt down for unknown length of time in her garden with ketoacidosis, smelled like canned pears and had fruit flies and ants on her. Lived another week in a SNF.

Ditto about the pt, a pregnant diabetic meth abuser who tried to borderline OD on insulin to precipitate an abortion, and was given meth to wake her up when she collapsed. Was the color of the background of this website, obtunded and gasping like a blue whale breeching. Lasted a couple days in ICU, lost the fetus and would have lost her arm to compartmental syndrome after so many ABG's. Or so the ICU told us.


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## BandageBrigade (Aug 17, 2012)

Not my patient, But not all that far from me (in the grand scheme considering other emtlife members locations at least..)

BAC .627 once he arrived at the hospital..


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## Shishkabob (Aug 17, 2012)

usalsfyre said:


> 300/220 secondary to cocaine overdose.



Darnit, I had 280/160.


Had a patient with 12 cardiac stents.



I had a patient last shift who claimed to have had the same cold for 2 years...


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## Melclin (Aug 17, 2012)

Had an old fella with a BP of 300+/220. None of our BP cuffs went any higher than 300 so we'll never know how high his systolic was. Standing height fall with head strike, on warfarin. I swear he was bleeding through his pores. Blood kept appearing on his cheeks but with no wounds that either myself or the doctor I was working with could identify.


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## mpena (Aug 18, 2012)

Roadside BAC done to 24 y.o. female after two vehicle Rollover/MVA (walking and talking mind you) BAC - 0.71

Lowest on scene BGL (walking/talking (slurred speech but understandable) BGL - 24


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## Jon (Aug 18, 2012)

Blood alcohol of .398, Alert and talking. Talk about a professional.
Blood alcohol of .45something? - Well, they lived.


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## Undaedalus (Aug 19, 2012)

For the record,

_In 1995, a man in Wrocław, Poland, had a car accident. At the hospital, his BAC was determined to be 1,48%. Concerned that their equipment was malfunctioning, doctors also performed five separate lab tests, all of which confirmed the man's blood alcohol content. He died a few days later from wounds from the car accident. Police were baffled as to how an individual could attain such a high blood alcohol. Later, police discussions with his brother in-law revealed that he had "beer bonged" pure grain alcohol allegedly stolen from his place of work, a chemical plant._

Per Wikipedia.  EMTLife.com doesn't trust my link, so find it yourself.


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## CANDawg (Aug 19, 2012)

PheasantPlucker said:


> For the record,
> 
> _In 1995, a man in Wrocław, Poland, had a car accident. At the hospital, his BAC was determined to be 1,48%. Concerned that their equipment was malfunctioning, doctors also performed five separate lab tests, all of which confirmed the man's blood alcohol content. He died a few days later from wounds from the car accident. Police were baffled as to how an individual could attain such a high blood alcohol. Later, police discussions with his brother in-law revealed that he had "beer bonged" pure grain alcohol allegedly stolen from his place of work, a chemical plant._
> 
> Per Wikipedia.  EMTLife.com doesn't trust my link, so find it yourself.



The actual source is http://www.wprost.pl/ar/9999/Rekord-w-promilach/?I=963, but it's in Polish and Google messes up the translation quite a bit.


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## CritterNurse (Aug 19, 2012)

The only extreme values I've seen so far were in animals.

Fastest heartrate I've seen on an ECG monitor was over 300 bpm from a rat during surgery.


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## medicsb (Aug 19, 2012)

I'm curious what the BAC of patients treated for ethylene glycol ODs reach.  There was a case report of a patient in Australia who required so much EtOH that the hospital pharmacy ran out and had to send someone to buy vodka from a local liquor store.


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## Jambi (Aug 19, 2012)

BP >300/270

Pt was sitting bolt upright and speaking in a robot voice while referring to herself in the third person.  

Making a name up:  "Barbara has a headache. Barbara is an alcoholic." 

Becomes unresponsive then starts posturing...massive subarachnoid bleed. :sad:


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## Jambi (Aug 19, 2012)

medicsb said:


> the hospital pharmacy ran out and had to send someone to buy vodka from a local liquor store.



The smartass in me wants to know if the cheap ghetto vodka in the plastic bottles would do, or of some middle or top shelf brand would be in order.  :lol:


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## medicman14 (Aug 19, 2012)

Epi-do said:


> Had a pt with a head injury that we couldn't get a BP on, because even taking the cuff up to 300, you immediately heard the beats as soon as you started deflating the cuff.  The ER thought we were full of crap when we told them his pressure was 300+ systolic, until they did it themselves and got the same results.



I've seen two patients that were off the scale of the bp cuff.


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## Sandog (Aug 19, 2012)

saskvolunteer said:


> Nope. I'm quite positive it was 39.7. None of us had ever seen. ABG was repeated by the RTs twice. He died shortly after.



I'm melting, melting...


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## Trashtruck (Aug 21, 2012)

Diabetic who read 'LO' on glucometer, meaning <20mg/DL on our machine...walking and talking to me...totally with it. No complaints. 

'No freakin' way.' Checked it again. No S#%T!? 

Sugared her up to a whopping 25mg/DL by the time we arrived at the hospital.

I double checked her sugar and used two separate glucometers...twice. 

Things like this make this thread possible.


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## abckidsmom (Aug 21, 2012)

Trashtruck said:


> Diabetic who read 'LO' on glucometer, meaning <20mg/DL on our machine...walking and talking to me...totally with it. No complaints.
> 
> 'No freakin' way.' Checked it again. No S#%T!?
> 
> ...



I had an insulinoma on my placenta during one of my pregnancies.  My sugar would get freaky low (8 mg/dL) and I was sluggish, but still awake.  

Crazy.


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## CANDawg (Aug 21, 2012)

abckidsmom said:


> I had an insulinoma on my placenta during one of my pregnancies.  My sugar would get freaky low (8 mg/dL) and I was sluggish, but still awake.
> 
> Crazy.



Is the mg/dL the standard measurement for blood glucose in the states? I was trained with mmol/l. It was a bit confusing at first as to why someone was noting a sugar of 8 as low, regular glucose in mmol/l is 3.8-7.0. :lol:


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## Anjel (Aug 22, 2012)

dbo789 said:


> Is the mg/dL the standard measurement for blood glucose in the states? I was trained with mmol/l. It was a bit confusing at first as to why someone was noting a sugar of 8 as low, regular glucose in mmol/l is 3.8-7.0. :lol:



Ya. I think 8mg is .3mol


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## Jon (Aug 23, 2012)

dbo789 said:


> Is the mg/dL the standard measurement for blood glucose in the states? I was trained with mmol/l. It was a bit confusing at first as to why someone was noting a sugar of 8 as low, regular glucose in mmol/l is 3.8-7.0. :lol:


Correct.

It's even more entertaining when a patient is here in the US from a Commonwealth country with a meter that measures in mmols.


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## tssemt2010 (Aug 24, 2012)

bp of 294/165, after 5 sprays of nitro the blood pressure dropped to 250/150


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## eprex (Aug 26, 2012)

saskvolunteer said:


> Nope. I'm quite positive it was 39.7. None of us had ever seen. ABG was repeated by the RTs twice. He died shortly after.



:rofl:


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## eprex (Aug 26, 2012)

Sandog said:


> I'm melting, melting...



pH > 7 is basic!


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## lightsandsirens5 (Aug 26, 2012)

BGL of 1700
BP of 310/220 (secondary to heat-stroke)
ETCo2 of 90 (not a dead one)


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## usalsfyre (Sep 5, 2012)

New one. 445 days as an inpatient and 97 discharging diagnosis...


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## abckidsmom (Sep 5, 2012)

usalsfyre said:


> New one. 445 days as an inpatient and 97 discharging diagnosis...



That's a real winner.

Hubby had a fairly impressive one today:

Temp: 93.4
Lactate 6.1
BP 92/40

Can you guess the address?


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## usalsfyre (Sep 5, 2012)

abckidsmom said:


> that's a real winner.
> 
> Hubby had a fairly impressive one today:
> 
> ...



10701?

I got my second field tube ever at that place...


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## abckidsmom (Sep 5, 2012)

usalsfyre said:


> 10701?
> 
> I got my second field tube ever at that place...



Old addresses never die.  I have 1900, 7246, and 4401.  I miss Richmond.


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## VFlutter (Sep 5, 2012)

A heart rate of 312, Patient hit an R-on-T pvc went into VT/Torsades for about 45 seconds before going into V fib. 

We had another patient who was a DNR who was in V fib for 27 mins before finally going asystole.


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## usalsfyre (Sep 5, 2012)

ChaseZ33 said:


> We had another patient who was a DNR who was in V fib for 27 mins before finally going asystole.



Reminds me of another one from my FFX days...14 defibs. You could smell the burning by the end of the call.


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## Tigger (Sep 5, 2012)

usalsfyre said:


> Reminds me of another one from my FFX days...14 defibs. You could smell the burning by the end of the call.



Had an arrest while doing clinicals where the patient received eight shocks to correct vfib on the way in and then 12 more in the hospital. "Survived" to ICU I think.


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## medicsb (Sep 5, 2012)

In one patient when I was a medic student (2004)... 

8mg of epi
3mg of atropine
200mg of lidocaine
100mEq of HCO3
1g of CaCl (new Dx of ESKD)
16? defibs
1 cardioversion
and I think we got TCP in there somewhere, too.

We got ROSC multiple times that lasted no more than a minute or two.

We worked her on scene for 30 minutes and then a 15-20 minute transport to the hospital.  

I also got my first field ETI on this call.


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## GaMedic (Sep 5, 2012)

Had a call the other day where it came out as an unknown emergency..

Aos to find an 77 y/o/f who was caox3.. BP 112/76 (around there dont remember exactly) bs equal and bilateral. BGL 20 and could have a conversation with you.. I told her congratulations.. That she has won the lowest BGL while being able to talk award... She laughed it off and finally agreed to go to the ER to get checked out..

A few months ago we ran a respiratory distress call.. AOS to find a middle 50's woman who was c/o DIB. started obtaining baseline vitals while my partner was getting hx and meds from her husband.. Pulse Ox showed her to be at 30%..
Needless to say she had a hypoxic seizure before we managed to get her to the truck. Ended up having to intubate and bag her en-route.. Never heard if she managed to come home after that trip.:sad:

Pt called for blood pressure issues.. AOS to find x aged female laying on the couch.. Pt stated that her home health nurse told her earlier that day she had Orthostatic hypotension.. Obtained baseline vitals etc..

BP while laying supine : 150/90
BP while sitting upright : 86/72
BP while standing : 70/30

Hands down the worst case of Orthostatic HTN I have ever seen.. Even the ER Dr was amazed..


Think she has an issue with Ejection Fraction..... Ya think?


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## Anjel (Sep 7, 2012)

BGL over 2000. 

Had a pt like that a couple days ago. She was 26 quit dialysis, quit taking insulin. 

She was unconsciously combative. And seized on us. 

RSI when we got to the ER. She is only expected to live a couple more days. 

PH was 7.3


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## MSDeltaFlt (Sep 7, 2012)

I apologize.  Just reread my post.  My 13K+ was discharged home and did NOT die.

Upgraded software on this @#%& phone.


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## usalsfyre (Sep 7, 2012)

Anjel1030 said:


> PH was 7.3


Wow...sounds more like HHNK. You usually expect a 7.0 or lower in a case like that...


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## Anjel (Sep 7, 2012)

usalsfyre said:


> Wow...sounds more like HHNK. You usually expect a 7.0 or lower in a case like that...



They were very confused. Her bicarbonate levels were low as well. They RSI'd and she kept bucking and fighting the vent in inspiration. 

The medic was arguing that something needed to come down from 600 to 500 on the vent settings. Forgive my ignorance with that area of things. Haven't quite got that far in class.


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## VFlutter (Sep 7, 2012)

Anjel1030 said:


> They were very confused. Her bicarbonate levels were low as well. They RSI'd and she kept bucking and fighting the vent in inspiration.
> 
> The medic was arguing that something needed to come down from 600 to 500 on the vent settings. Forgive my ignorance with that area of things. Haven't quite got that far in class.



I am assuming tidal volume?

Here is a good write up on vents And ABGs

http://www.icufaqs.org/ventFAQ.doc


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## Anjel (Sep 7, 2012)

ChaseZ33 said:


> I am assuming tidal volume?
> 
> Here is a good write up on vents And ABGs
> 
> http://www.icufaqs.org/ventFAQ.doc



Oh awesome. Thanks a bunch.


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## VFlutter (Sep 7, 2012)

GaMedic said:


> Hands down the worst case of Orthostatic HTN I have ever seen.. Even the ER Dr was amazed..
> 
> 
> Think she has an issue with Ejection Fraction..... Ya think?



What makes you think she has an issue with her EF? Usually it's the other end of the system causing the problem....


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