# 60 y/o Dialysis PT



## KyleG (Sep 29, 2012)

AOS at Dialysis Center to take PT back to SNF from Dialysis. PT States During Dialysis she had a *cramping* pain in her chest. *Ax*: Sudden Onset that happened during dialysis that she rates at a 9 but went away with rest.* Hx: * COPD ESRD. *Rx* PT already on O2. _*Tx:*_ PT to a ER. (w/o a 12 lead its unconfirmed but it also was a STEMI center) 

Just found out today that the pt was admitted to the hospital for a week at least. no further updates 

What could it be?


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## Aidey (Sep 29, 2012)

She is a dialysis patient. They always get admitted. They are the ultimate train wrecks.


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## VFlutter (Sep 29, 2012)

Aidey said:


> She is a dialysis patient. They always get admitted. They are the ultimate train wrecks.



+1

That isn't really much information to go off of....


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## Handsome Robb (Sep 29, 2012)

Could be an electrolyte imbalance, could be an AMI/STEMI, could be angina, could be pleuritic pain, could be cramps...could be lots of things. Without further diagnostics or information we can't really tell you much.


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## NYMedic828 (Sep 29, 2012)

KyleG said:


> AOS at Dialysis Center to take PT back to SNF from Dialysis. PT States During Dialysis she had a *cramping* pain in her chest. *Ax*: Sudden Onset that happened during dialysis that she rates at a 9 but went away with rest.* Hx: * COPD ESRD. *Rx* PT already on O2. _*Tx:*_ PT to a ER. (w/o a 12 lead its unconfirmed but it also was a STEMI center)
> 
> Just found out today that the pt was admitted to the hospital for a week at least. no further updates
> 
> What could it be?



Could be literally anything for the sake of not repeating everyone above me.


On a side note. First thing I would of done aside from a full assessment is take the O2 mask off her because it serves no purpose.


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## VFlutter (Sep 29, 2012)

NYMedic828 said:


> Could be literally anything for the sake of not repeating everyone above me.
> 
> 
> On a side note. First thing I would of done aside from a full assessment is take the O2 mask off her because it serves no purpose.



I personally would nebulize some Maalox followed by CPAP with the PEEP set at "cray cray" and an IV push of Vanco... Just to cover all the bases.

If that doesn't work you can always try a potassium chloride enema


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## NYMedic828 (Sep 29, 2012)

ChaseZ33 said:


> I personally would nebulize some Maalox followed by CPAP with the PEEP set at "cray cray" and an IV push of Vanco... Just to cover all the bases.
> 
> If that doesn't work you can always try a potassium chloride enema



Showoff -_-


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## KyleG (Oct 10, 2012)

Cant take off the O2 she is cronically on o2 for COPD and its only Nasal at 2 lpm.

and im just BLS no drugs on board just using this call as a learning experience.


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## truetiger (Oct 10, 2012)

Why isn't this an ALS call?


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## martor (Oct 10, 2012)

Cramping during dialysis is common if they eat something they are not allowed. Good call on tx to hospital and not going to SNF (they sure as hell wont help the pt. -_-) If pt complained about radiating pain, has hx of CVD, and/or described pain as pressure on her chest; I would have called ALS en route.


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## leoemt (Oct 10, 2012)

truetiger said:


> Why isn't this an ALS call?



Why would you call ALS? Do you want us calling you for every case of abdominal pain? There is nothing to indicate upgrading to ALS is necessary. Just because ALS can give pain meds doesn't mean I am calling ALS. If thats the case might as well dispatch ALS to every call.

Dialysis patients are chronically in pain. Typically they will have prescription meds for pain and nausea waiting for them at the SNF.


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## truetiger (Oct 10, 2012)

Oh I dunno, the "cramping pain" in the chest?


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## Aidey (Oct 10, 2012)

leoemt said:


> Why would you call ALS? Do you want us calling you for every case of abdominal pain? There is nothing to indicate upgrading to ALS is necessary. Just because ALS can give pain meds doesn't mean I am calling ALS. *If thats the case might as well dispatch ALS to every call.*
> 
> Dialysis patients are chronically in pain. Typically they will have prescription meds for pain and nausea waiting for them at the SNF.



Now you are catching on. A dialysis patient with an acute complaint is ALS. They are complicated patients at high risk for multiple serious issues.


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## Handsome Robb (Oct 10, 2012)

Aidey said:


> Now you are catching on. A dialysis patient with an acute complaint is ALS. They are complicated patients at high risk for multiple serious issues.



What she said.


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