abckidsmom
Dances with Patients
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1130 on a Tuesday, you're dispatched 3 dues away for an unknown medical problem. Caller states pt wasn't acting right, and now has an altered mental status. History of MI and HTN.
During your response, first responders arrive and upgrade the call to a cardiac arrest, then correct themselves and states that the patient is unresponsive with snoring respirations.
On arrival, you find the 45 yom unresponsive to painful stimulus, with fast, deep respirations, airway is clear, he accepts an NPA. Skin is hot, red and sweaty...it's about 80 in the room, and a hot day. You see a couple of scrapes on his elbows and the lateral side of one hand.
Initial vitals:
P: 138
BP: 230/124
R: 32, deep, BBS clear
T: 99.8
SpO2: 86% RA
CBG: 164
You talk to the family, and they say they aren't too sure what happened, he'd been feeling weak and crabby all day, and was sitting in the chair when he stopped responding. Some minutes later, after first responders were there, he somehow fell out of the chair. The family present is the patient's mother, who is not a very good historian, and doesn't have many deatils. She is able to fill you in on his PMH:
MI 2 years ago, with 4 stents placed
HTN, poorly controlled
Meds:
Clonidine 0.3 mg tabs QID
Simvastatin
Lisinopril 40 mg BID
Plavix
When you get him up on the stretcher, he regains consciousness enough to pull the NPA, yank at the oxygen mask, and generally be a little combative. His gaze is empty, and he is aphasic.
In the ambulance the head to toe looks like this:
HEENT: Pupils are 3 mm L/2 mm R, R facial droop, no JVD in high semifowlers, no trauma noted
Resp: BBS clear and equal, respirations still deep and rapid, mild accessory muscle use
CV: Skin warm and moist, no longer red. Radial pulses are bounding. BLEs mottled and dusky, cool and pulseless. EKG Sinus tach, no ectopy, no signs of ischemia or infarct on 12 lead
Abd: Firm with ascites, no masses on palpation, liver is palpable well below the costal margin.
GI/GU: No incontinence, no reported GI complaints.
Extremities: As noted, with mild abrasions to BUEs. No movement of RUE, pt is combative with LUE.
You're an hour from the closest hospital, 25 minute ETA of closest helicoptor. You're on the truck today with your BLS partner, and the BLS first responders look at you and say "what do you need?"
During your response, first responders arrive and upgrade the call to a cardiac arrest, then correct themselves and states that the patient is unresponsive with snoring respirations.
On arrival, you find the 45 yom unresponsive to painful stimulus, with fast, deep respirations, airway is clear, he accepts an NPA. Skin is hot, red and sweaty...it's about 80 in the room, and a hot day. You see a couple of scrapes on his elbows and the lateral side of one hand.
Initial vitals:
P: 138
BP: 230/124
R: 32, deep, BBS clear
T: 99.8
SpO2: 86% RA
CBG: 164
You talk to the family, and they say they aren't too sure what happened, he'd been feeling weak and crabby all day, and was sitting in the chair when he stopped responding. Some minutes later, after first responders were there, he somehow fell out of the chair. The family present is the patient's mother, who is not a very good historian, and doesn't have many deatils. She is able to fill you in on his PMH:
MI 2 years ago, with 4 stents placed
HTN, poorly controlled
Meds:
Clonidine 0.3 mg tabs QID
Simvastatin
Lisinopril 40 mg BID
Plavix
When you get him up on the stretcher, he regains consciousness enough to pull the NPA, yank at the oxygen mask, and generally be a little combative. His gaze is empty, and he is aphasic.
In the ambulance the head to toe looks like this:
HEENT: Pupils are 3 mm L/2 mm R, R facial droop, no JVD in high semifowlers, no trauma noted
Resp: BBS clear and equal, respirations still deep and rapid, mild accessory muscle use
CV: Skin warm and moist, no longer red. Radial pulses are bounding. BLEs mottled and dusky, cool and pulseless. EKG Sinus tach, no ectopy, no signs of ischemia or infarct on 12 lead
Abd: Firm with ascites, no masses on palpation, liver is palpable well below the costal margin.
GI/GU: No incontinence, no reported GI complaints.
Extremities: As noted, with mild abrasions to BUEs. No movement of RUE, pt is combative with LUE.
You're an hour from the closest hospital, 25 minute ETA of closest helicoptor. You're on the truck today with your BLS partner, and the BLS first responders look at you and say "what do you need?"
