Ridryder911
EMS Guru
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Okay kiddos.. put on your thinking cap!
Here is a typical call, that reminds me of the old saying ... If you hear galloping hooves, think of Zebras! ....
You are dispatched to a rural area in your response area on a "post colonoscopy pain".. You and your mumble .. on disgust.
After arriving 25 minutes after dispatch, you arrive to a double wide trailer with several cars in the front yard with out of state license tags.
You are met by a "waver" that greet you to the front door. You then met by three elderly females describing that their "sister is from out of state and has had problems"... as you wind to the back bedroom you finally see your patient laying in bed.
Your initial across the room assesment is an elderly female approximate 80 years old that appears pale. She is very conscous and alert. You ask what is the "problem" and she describes she "has not had a bowel movement in the past three days". You inquire about the colonoscopy and was informed it was in 1969! You then ask ..confused 1969 ?.. The patient reconfirms... after questioning more, you find out they intended to say.."colostomy" in 1969. .. oh.. okay!..at least this makes sense
Initial history:
History: Patient is from out of state. Describes " feeling weak this past few hours".. she has had multiple medical problems. She did have the colostomy in 1969, with bowel removal due to colon cancer and has had no reoccurrences. A "large heart attack" approximately 6 years ago and currently ony being treated for HTN, and prophylactic cardiac such as ASA, NTG (prn), and Prilosec for GERD. Denies any food, latex, or drug allergies.
You decide to do a quick assessment and find an 80 year old female with no complaints except generalize weakness and no noted stool in her colostomy bag for three days. Brief overview patient is alert. well orientated and no noted gross neuro deficits, bi-lat symmetry with lung sounds clear, abdomen is round, soft with noted colostomy bag attached, (and inside visually see noted scant brown stool). Peripheral pulses are very weak and blood pressure is hard to obtain .. according to volunteer first responder.
You realize that you will not be able place stretcher into room, patient refuses to allow you to carry .. and you allow her to gradually sit on the side of the bed. She does without difficulties. She definitely, wants to "ambulate" to the stretcher against your recommendation not to. She does so and approximately 5 steps become syncopal. She is immediately placed onto the stretcher, where she becomes immediately alert again.
You place her into your unit to perform a better assessment and start initial treatment.... You are approximately 30 miles from an a ER.
Now what ?
Here is a typical call, that reminds me of the old saying ... If you hear galloping hooves, think of Zebras! ....
You are dispatched to a rural area in your response area on a "post colonoscopy pain".. You and your mumble .. on disgust.
After arriving 25 minutes after dispatch, you arrive to a double wide trailer with several cars in the front yard with out of state license tags.
You are met by a "waver" that greet you to the front door. You then met by three elderly females describing that their "sister is from out of state and has had problems"... as you wind to the back bedroom you finally see your patient laying in bed.
Your initial across the room assesment is an elderly female approximate 80 years old that appears pale. She is very conscous and alert. You ask what is the "problem" and she describes she "has not had a bowel movement in the past three days". You inquire about the colonoscopy and was informed it was in 1969! You then ask ..confused 1969 ?.. The patient reconfirms... after questioning more, you find out they intended to say.."colostomy" in 1969. .. oh.. okay!..at least this makes sense
Initial history:
History: Patient is from out of state. Describes " feeling weak this past few hours".. she has had multiple medical problems. She did have the colostomy in 1969, with bowel removal due to colon cancer and has had no reoccurrences. A "large heart attack" approximately 6 years ago and currently ony being treated for HTN, and prophylactic cardiac such as ASA, NTG (prn), and Prilosec for GERD. Denies any food, latex, or drug allergies.
You decide to do a quick assessment and find an 80 year old female with no complaints except generalize weakness and no noted stool in her colostomy bag for three days. Brief overview patient is alert. well orientated and no noted gross neuro deficits, bi-lat symmetry with lung sounds clear, abdomen is round, soft with noted colostomy bag attached, (and inside visually see noted scant brown stool). Peripheral pulses are very weak and blood pressure is hard to obtain .. according to volunteer first responder.
You realize that you will not be able place stretcher into room, patient refuses to allow you to carry .. and you allow her to gradually sit on the side of the bed. She does without difficulties. She definitely, wants to "ambulate" to the stretcher against your recommendation not to. She does so and approximately 5 steps become syncopal. She is immediately placed onto the stretcher, where she becomes immediately alert again.
You place her into your unit to perform a better assessment and start initial treatment.... You are approximately 30 miles from an a ER.
Now what ?
