Melclin
Forum Deputy Chief
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Nobody seems to have been too interested in my last scenario so maybe people will be more interested in ones I got wrong rather than my successes.
Its a cool afternoon and you are called to a doctors surgery for a 65 year old female, Gwen, who has collapsed out front.
You find a skinny looking lady sitting on an exam table with a em bag looking a bit pale.
Characteristically abysmal handover: Gwen came to see him for the first time yesterday complaining of SOBOE and came back in for some blood tests today. While walking into the surgery, she was seen to collapse to the ground with a minimal period of LOC. He has no idea what's wrong.
Illness hx: Pt first noticed SOB on exertion two weeks ago and feels it has steadily worsened since then. She notes that it is particularly bad in the cold weather. Upon waking this morning she has experienced worsening nausea but feels that this is normal for her when she hasn't eaten after taking her bp medication. She complains that she felt dizzy walking into the doctors office, and remembers feeling like she was going to fall and waking up on the ground. She reports no warmth in the face or nausea prior to fainting.
Hx
Hypertension - she states usually well controlled.
2008 - GP apparently found blood in her stool (why he was looking in the first place was unclear) and ordered a colonoscopy which showed no lower GI abnormalities and apparently it was left at that.
Recently in good health (other than SOBOE), regular exercise, non-smoker, no surgeries or hospital admissions, vegetarian, no recent O/S travel/flights, eating, drinking, opening bowels and urinating as normal.
O/E: BP: 140/90, Pulse: 86 (strong, regular), Tympanic temp: 36.3, Resps: 24, GCS: 15. BSL: 5.7 (about 110 in mg/dl I think). Monitored in a SR of 86. I lost her strip, which annoys me because I wanted to post it. From memory rS wave and inverted T wave in II but otherwise normal. No 12 lead available.
PEARL, sclera are white, distal pulses and all present and normal, chest is clear and equal, no accessory muscle use, mild anxiety is evident, abdomen soft and happy, nil c-spine tenderness, distal neuro obs are good.
There is a small abrasion on her forehead and complains of pain in both knees which are red (presumably from falling foward onto them). Pt is no longer dizzy.
Shoot.
Its a cool afternoon and you are called to a doctors surgery for a 65 year old female, Gwen, who has collapsed out front.
You find a skinny looking lady sitting on an exam table with a em bag looking a bit pale.
Characteristically abysmal handover: Gwen came to see him for the first time yesterday complaining of SOBOE and came back in for some blood tests today. While walking into the surgery, she was seen to collapse to the ground with a minimal period of LOC. He has no idea what's wrong.
Illness hx: Pt first noticed SOB on exertion two weeks ago and feels it has steadily worsened since then. She notes that it is particularly bad in the cold weather. Upon waking this morning she has experienced worsening nausea but feels that this is normal for her when she hasn't eaten after taking her bp medication. She complains that she felt dizzy walking into the doctors office, and remembers feeling like she was going to fall and waking up on the ground. She reports no warmth in the face or nausea prior to fainting.
Hx
Hypertension - she states usually well controlled.
2008 - GP apparently found blood in her stool (why he was looking in the first place was unclear) and ordered a colonoscopy which showed no lower GI abnormalities and apparently it was left at that.
Recently in good health (other than SOBOE), regular exercise, non-smoker, no surgeries or hospital admissions, vegetarian, no recent O/S travel/flights, eating, drinking, opening bowels and urinating as normal.
O/E: BP: 140/90, Pulse: 86 (strong, regular), Tympanic temp: 36.3, Resps: 24, GCS: 15. BSL: 5.7 (about 110 in mg/dl I think). Monitored in a SR of 86. I lost her strip, which annoys me because I wanted to post it. From memory rS wave and inverted T wave in II but otherwise normal. No 12 lead available.
PEARL, sclera are white, distal pulses and all present and normal, chest is clear and equal, no accessory muscle use, mild anxiety is evident, abdomen soft and happy, nil c-spine tenderness, distal neuro obs are good.
There is a small abrasion on her forehead and complains of pain in both knees which are red (presumably from falling foward onto them). Pt is no longer dizzy.
Shoot.
h34r:
