57 yo F - AMS

[blindsideflank]

im surprised the infection has not been discussed more. systemic problem and a possible lung (V/Q) problem?
you know her well though, what are normal vitals?
and any change in her meds/doses?
certain antibiotics can be nephrotoxic, cause changes in warfarin (was she on this?) or beta blocker absorption.
im sure there is more but im just trying to look at this in the manner of "whats new for this pt?"

lots of questions about the bradycardia... I would conservatively bolus and watch the response but 500 ml's might be the tip of the iceberg when it comes to what she needs. (or could put her over and shes dead).....
considering Ca/pressors but you dont make friends in the ED by guessing with your treatments
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transport CXR, labs etc.

 

[Carlos Danger]

History is probably themost important part.

It is often said in medicine that a good history often can lead to a Dx even without an exam. I am not sure if there are any studies on it, but it seems to be very true.

I've several times heard reference to some research that showed that something like 90% of the information needed make most diagnoses could be gleaned from history alone.

Or maybe it was 90% of diagnoses could be made by history alone.

I don't remember. I don't even know if it's real.

 

[Veneficus]

I've several times heard reference to some research that showed that something like 90% of the information needed make most diagnoses could be gleaned from history alone.

Or maybe it was 90% of diagnoses could be made by history alone.

I don't remember. I don't even know if it's real.

I have heard this many times, I have never seen a study on it. From my experience it seems to hold true.

 

[FLdoc2011]

Not sure why people are having an issue with CPAP on a trach..... I put people with trachs on CPAP routinely.

CPAP is a mode of ventilation.... it does not just refer to the noninvasive mode involving a facemask.

All you're doing is connecting the vent tubing to the trach instead of an ETT. I also routinely put folks with an ETT on CPAP as well during the weaning process.

 

[Veneficus]

Not sure why people are having an issue with CPAP on a trach..... I put people with trachs on CPAP routinely.

CPAP is a mode of ventilation.... it does not just refer to the noninvasive mode involving a facemask.

All you're doing is connecting the vent tubing to the trach instead of an ETT. I also routinely put folks with an ETT on CPAP as well during the weaning process.

I think it may have to do with the equipment set up.

Most EMS CPAP machines are not vents wit CPAP and usually only have a mask.

 

[Aidey]

I think that is the issue. Most of the CPAPs carried on ambs resemble the set ups used at home, not a vent.

 

[VFlutter]

Not sure why people are having an issue with CPAP on a trach..... I put people with trachs on CPAP routinely.

CPAP is a mode of ventilation.... it does not just refer to the noninvasive mode involving a facemask.

All you're doing is connecting the vent tubing to the trach instead of an ETT. I also routinely put folks with an ETT on CPAP as well during the weaning process.

I think it may have to do with the equipment set up.

Most EMS CPAP machines are not vents wit CPAP and usually only have a mask.

We also routinely use CPAP on trached patients but as Vene mentioned we use much better CPAP/Vent units in the hospital then that what EMS has available.

Depending on your CPAP unit you may have some trouble with non cuffed trachs which this lady may likely have. If our patients have a non cuffed trach we will switch it out for a cuffed one before using CPAP/BiPAP. Or you could bump up the pressures to temporarily compensate.

 

[FLdoc2011]

Kind of what I figured.

Not sure what vents our agency here carries. I know our ER has some very basic ones.