abckidsmom
Dances with Patients
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Dispatched for a 68 yom complaining of difficulty breathing. The additional says he has no medical history and has had difficulty breathing all night, now is unable to speak.
On arrival, he's upstairs in the back bedroom with a fan blowing on his face, tripoding, gasping for air, generally looking gray, with purple lips. He's an overweight guy with a huge belly, varicosities, and clubbed fingernails.
One glance tells you that you want to get out of the house immediately. The partner is sent for the stair chair and you call back to the station to let them know you're going to be picking up an additional provider on the way to the hospital.
While the partner is getting the stair chair, you throw him on a non rebreather.
Initial vitals:
BP: 280/150
HR: 200
RR: 40
SpO2: 72%
Lungs sound wheezy throughout, with minimal air movement, and sound coarse in the bases. There is lots of accessory muscle use, and the patient is very anxious, with no other complaints. He specifically denies chest pain, nausea or vomiting. He also denies any medical history, says he hasn't been to the doctor in years, no known allergies.
On the monitor, he's got an EtCO2 of 48, with a shark fin wave form, and the 12 lead shows afib with RVR, no elevations or signs of ischemia on the 12 lead.
You throw him on the CPAP at 7.5 of PEEP, he settles into that pretty well.
5 minutes later the vitals go like this:
BP: 168/80
HR: 190
RR: 44
SpO2: 97%
EtCO2: 46
You're working on getting access, struggling to find a vein, and trying to think up a plan. What's your plan? What are you thinking?
On arrival, he's upstairs in the back bedroom with a fan blowing on his face, tripoding, gasping for air, generally looking gray, with purple lips. He's an overweight guy with a huge belly, varicosities, and clubbed fingernails.
One glance tells you that you want to get out of the house immediately. The partner is sent for the stair chair and you call back to the station to let them know you're going to be picking up an additional provider on the way to the hospital.
While the partner is getting the stair chair, you throw him on a non rebreather.
Initial vitals:
BP: 280/150
HR: 200
RR: 40
SpO2: 72%
Lungs sound wheezy throughout, with minimal air movement, and sound coarse in the bases. There is lots of accessory muscle use, and the patient is very anxious, with no other complaints. He specifically denies chest pain, nausea or vomiting. He also denies any medical history, says he hasn't been to the doctor in years, no known allergies.
On the monitor, he's got an EtCO2 of 48, with a shark fin wave form, and the 12 lead shows afib with RVR, no elevations or signs of ischemia on the 12 lead.
You throw him on the CPAP at 7.5 of PEEP, he settles into that pretty well.
5 minutes later the vitals go like this:
BP: 168/80
HR: 190
RR: 44
SpO2: 97%
EtCO2: 46
You're working on getting access, struggling to find a vein, and trying to think up a plan. What's your plan? What are you thinking?