Anxiety Attack?

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GonziEms22

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So hi everyone, this is my first time posting....
......So I work for company that does BLS and ALS runs that also include code3 Transport.
My Scenario goes as follows

Let me add that we had made contact with this PT 2days ago, her VS BP 132/74 P68 R16 FULL, A&OX4....Cont. O2 2lpm via NC
we transported to her facility w/ no incident
2days later...
We're dispatch for a T2 transport to dialysis 67yo, F.... same one that we had made contact w/ 2days ago.....
I made contact, right away I notice she's AMS A&OX1 R24 BP 162/78 P92
Cc chest pain just below the sternum
Went to through the how assessment found no S/S of possible CHF or of a possible CVA
5min in my partner shows up who got a report from a nurse BP 108/64 p 68 really?
I go talk to the nurse, who says off the bat ...oh she has ANXIETY ATTACKS just before dialysis....ignores my findings....no she has to go! Yelling at this point.... I express to her that the PT is calm I don't believe she's having an anxiety attack....all while my partner is re assesing VS same findings BP is now 174/ 78 p94 R24 ....nurse is angry at us....she walks w/ me towards the patient ....

10min. In PT starts vomiting....we quickly lift her back higher on bed semifowlers....I take off her NC and replace with a mask start with 10lpm nurse is completely mad at this point telling us that she has to go dialysis starts calling the doctor leaves the room...I express that we will not be transporting she is currently not stable....we decide to call fire because we do not have contract in that region of Los Angeles 15min in fire arrives
Medic gets same findings BP IS now 186/74, nurse tells them that we over reacted....fire looks at her and says you call that an ANXIETY ATTACK?.....so we transfer PT to medics......
so that whole day I kept asking my self what does an anxiety attack look like the PT was calm and kept addressing chest pain just below the sternum
At no point was she freaking out....I believe that transferring to fire was the right thing to do... please add any taught thanks.......oh and PT was SO2 97 the whole time.. we have not heard anything about this call yet....
 
I'm confused as to how you got called to the dialysis center? You obviously don't have a 911 contract, and the nurse was angry at you that the patient is fine so she obviously wouldn't have called you. If the patient is getting ready to start dialysis at the center, how does a BLS IFT crew involve themselves?
 
The first part was when picked her from dialysis.....the second time we were called to to take her to dialysis from her care center and it was at this time the situation presented itself at the care facility when we were going to take her to dialysis..
 
none of those vitals have me terribly concerned in a 67y/o who is sick enough to need dialysis and live in a care facility. A bit concerning that her mental status deteriorated to A&Ox1...but again, she is sick already. Not enough info here to rule in/out any source of infection, does not sound like stroke...

Clinical acumen would dictate your actions here. If you think something is wrong then upgrading to ALS is not a bad idea. Would I have done the same thing? I don't know, tough call without being there and have a "gut" feeling. Maybe brewing a UTI, maybe just needs dialysis.

What was your concern with this patient? What was on your differential?
 
My concern was that 10min ago before our arrival the nurse gave us her last VS 108/64 P 68 R16.....she stated that these were recently taken before our arrival and that she's fully alert....when we made contact my findings were of HTN emergency PT was tachycardia, tachypnea, AMS, VOMITING, BP over 170 systolic and rising.... nurse said it's ANXIETY ATTACK but at no point did the PT show any signs of anxiety, it was just a feeling that the nurse had no idea what her actual VS were when the CNA stated she didn't notice anything like this before....that's when the gut feeling kicked in to ALS.... it was a relieve when the medical ruled out anxiety....but I was still stuck with the thought that she was already sick and needed dialysis....but our findings pointed towards ALS when compared to the nurses report..
 
First, I'll give you two pieces of knowledge sense you are new that will help you understand the situation better:

1. You typically care for one patient at a time. That CNA probably has 20-30 patients and the nurse probably has a similar number. That is why they might seem iffy on specifics (their attention is divided) and their idea of "recent vitals" is very different from yours since you were undoubtedly taught q15m minimum for stable patients. Depending on the level of care at that SNF or ALF or whatever, they are probably doing vitals and assessments every 8-12 hours unless there is a reason to do them more often.

2. Anxiety can present different ways, particularly in the elderly who have chronic illnesses and organ failure. Even in the young, anxiety doesn't have to present as a full blown panic attack as you might be thinking.

Now, you give me a few things:

1. What is the Pmhx on this patient?

2. What do you expect your vitals and exam findings to be in a pre-dialysis patient and why?

3. What do you expect your vitals to be in an anxious patient and how might a patient with multiple chronic illnesses present differently?

4. Try paragraphs and complete sentences instead of a 300 word run-on strung together by ellipses.
 
Gonzi, I really suggest that you take a good look at what Summit is asking you to do and really dive into this. You'll get a better understanding of what's going on if you do. There are quite a few people here that are very experienced Paramedics, Nurses (combinations of Paramedic and Nurse), Physician Assistants, and I think even a couple of Physicians. We want you to understand what's going on so that you become a better clinician and not just someone that blindly follows protocol but we're not going to spoon-feed you the info you need to get there but we (usually) will point you in the right direction.
 
I would not be concerned with a pre-dialysis pressure as is presented here. As others have said, I won't say why, that is for the OP to decide. I don't see a problem with the pt going to dialysis. I question why the pt was placed on a nonrebreather. What was the indication?
 
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