Epi-do
I see dead people
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Here's a recent run that we had. Just curious if anyone had any comments for me.
Dispatch: difficulty breathing, upgraded to cardiac arrest
Scene: We arrive to find a new, well-kept home with a couple people in the front yard. The patient is sitting in a chair at the kitchen table. Her daughter in on the phone and a neighbor is next to her.
Pt's story: She states she had been in the kitchen fixing something to eat and began feeling dizzy. She walked over to the table and had a seat, and the next thing she knows, she is on the floor. She has no idea how she got there. She has had similar episodes where she has felt dizzy, but it always passes if she sits down and she has never "passed out" before. She also gets easily winded when going up/down the stairs, but is able to walk around the house or yard without any difficulty. She denies any increase in the incidence of these episodes of dizziness or getting winded.
Daughter's story: My mom was in the kitchen when she got this "look" on her face and sat down at the kitchen table. She has spells where she gets dizzy, so I just assumed that is what was going on. She had her face in her hands and was breathing funny. I went to finish fixing her food for her and noticed that she was sort of slumped over. She didn't look like she was breathing, so I called 911 and also called my neighbor to come help. I called her name and she didn't respond to me. She had a stress test done sometime during the first part of July and it was ok. The doctor told us that whatever she is doing, she needs to keep doing it because she looks great for being 80. I have noticed that she has been having these dizzy moments a bit more frequently than in the past.
Neighbor's story: I came over when I heard <daughter> calling for help. I came into the house and <patient> was in the chair, not responding to anyone and it didn't look like she was breathing. I pulled her out of the chair and laid her on the floor to start CPR when she suddenly started breathing again. She came too and I helped her back into the chair.
Initial impression: The pt is an elderly black female, sitting in a chair. She is pale, cool, and diaphoretic and her respiratory effort is slightly labored. She is A&Ox3.
PE: BBS=slight wheezes at bases of both lungs; PERL; + PMSx4 extremeties; radial pulse is undetectable; HR=60 (obtained by listening to heart w/ steth.); no obvious signs of any sort of trauma noted
The patient denies difficulty breathing/SOB, CP, dizziness, N/V, or any pain. She states she has not fallen, had any other type of trauma, or any recent medical procedures.
PMHx/RX/Alg.: 2 different statins for hyperlipidemia. Atenolol and Diovann for htn. Also takes potassium. The patient states she is confident she did not take to much of any of her meds, either accidentally or intentionally. She has had no recent changes in dosage, and has been on all meds for quite some time. She denies any other history or meds.
She has NKA.
Vital signs: blood sugar 157 mg/dL; initial BP 92/58; RR 14-16
Tx: albuterol 2.5 mg via neb w/ O2 @ 8 lpm; IV established (18 g LAC) w/ 250 ml NaCl given throughout transport; cardiac monitor & 12 lead performed
The initial strip and 12 lead were as follows:
Changes during transport to ER: Albuterol alleviated the wheezes, and the patient was switched from a neb (once completed) to N/C @ 4 lpm; skin now pink, cool, clammy
If there is anything else you want to know, just ask. I will do my best to remember any additional details.
I'm just looking for general comments. I realize protocols vary from area to area, but am curious if anyone would do anything differently. I would love to know why she became syncopal, but don't know if I will be able to get back to that particular ER to follow up. I know there are countless things that could have caused it, especially given her age. I am wondering if something may have caused her to brady way down, until she wasn't perfusing adequately, leading to the syncope. What does everyone else think?
Dispatch: difficulty breathing, upgraded to cardiac arrest
While enroute, dispatch advises that a woman called, stated her mom was having problems breathing, suddenly screams that she has stopped breathing all together, and then hangs up the phone. The dispatcher tries to call back, but no one answers the phone.
Scene: We arrive to find a new, well-kept home with a couple people in the front yard. The patient is sitting in a chair at the kitchen table. Her daughter in on the phone and a neighbor is next to her.
Pt's story: She states she had been in the kitchen fixing something to eat and began feeling dizzy. She walked over to the table and had a seat, and the next thing she knows, she is on the floor. She has no idea how she got there. She has had similar episodes where she has felt dizzy, but it always passes if she sits down and she has never "passed out" before. She also gets easily winded when going up/down the stairs, but is able to walk around the house or yard without any difficulty. She denies any increase in the incidence of these episodes of dizziness or getting winded.
Daughter's story: My mom was in the kitchen when she got this "look" on her face and sat down at the kitchen table. She has spells where she gets dizzy, so I just assumed that is what was going on. She had her face in her hands and was breathing funny. I went to finish fixing her food for her and noticed that she was sort of slumped over. She didn't look like she was breathing, so I called 911 and also called my neighbor to come help. I called her name and she didn't respond to me. She had a stress test done sometime during the first part of July and it was ok. The doctor told us that whatever she is doing, she needs to keep doing it because she looks great for being 80. I have noticed that she has been having these dizzy moments a bit more frequently than in the past.
Neighbor's story: I came over when I heard <daughter> calling for help. I came into the house and <patient> was in the chair, not responding to anyone and it didn't look like she was breathing. I pulled her out of the chair and laid her on the floor to start CPR when she suddenly started breathing again. She came too and I helped her back into the chair.
Initial impression: The pt is an elderly black female, sitting in a chair. She is pale, cool, and diaphoretic and her respiratory effort is slightly labored. She is A&Ox3.
PE: BBS=slight wheezes at bases of both lungs; PERL; + PMSx4 extremeties; radial pulse is undetectable; HR=60 (obtained by listening to heart w/ steth.); no obvious signs of any sort of trauma noted
The patient denies difficulty breathing/SOB, CP, dizziness, N/V, or any pain. She states she has not fallen, had any other type of trauma, or any recent medical procedures.
PMHx/RX/Alg.: 2 different statins for hyperlipidemia. Atenolol and Diovann for htn. Also takes potassium. The patient states she is confident she did not take to much of any of her meds, either accidentally or intentionally. She has had no recent changes in dosage, and has been on all meds for quite some time. She denies any other history or meds.
She has NKA.
Vital signs: blood sugar 157 mg/dL; initial BP 92/58; RR 14-16
VS enroute to ER as follows:
Tx: albuterol 2.5 mg via neb w/ O2 @ 8 lpm; IV established (18 g LAC) w/ 250 ml NaCl given throughout transport; cardiac monitor & 12 lead performed
The initial strip and 12 lead were as follows:
Changes during transport to ER: Albuterol alleviated the wheezes, and the patient was switched from a neb (once completed) to N/C @ 4 lpm; skin now pink, cool, clammy
If there is anything else you want to know, just ask. I will do my best to remember any additional details.
I'm just looking for general comments. I realize protocols vary from area to area, but am curious if anyone would do anything differently. I would love to know why she became syncopal, but don't know if I will be able to get back to that particular ER to follow up. I know there are countless things that could have caused it, especially given her age. I am wondering if something may have caused her to brady way down, until she wasn't perfusing adequately, leading to the syncope. What does everyone else think?
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