Case study

DesertMedic66 said:
Based on what you presented, a matter of seconds is not going to make any difference in the patients outcome. It is very easy to give a decent hand over in under a minute. If you are rolling into your hospitals and just providing them with that report then you really need to work on giving better reports.
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No have you been handed over someone when its about a wrap?
 
Frank frankerson ESQ said:
********. When someone says they think they are going to die its rare. I could care less about 30 years of 2 calls a day avg or whatever fundraiser youre doinf

go blow country smoke up someone elses but
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Hahahaha. It is rare? It might be in the system you are in however it is not rare in the system I am in. Rolling up to frequent flyer Susan who is standing curbside with luggage saying “I’m gonna die, I need to go to the hospital now” is a normal occurrence.

And no thanks. I gave up my smoking habit several years ago.
 
Frank frankerson ESQ said:
And yes seconds count.
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In some select cases seconds do count however not in this case.
Frank frankerson ESQ said:
Have you been to a nursing home?
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All the time. Usually my patients who are “mentally “ok” are able to remember some history after being questioned. If not there is paperwork and medication lists that I use.
Frank frankerson ESQ said:
You are full of **** dude
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I’d have to ask my proctologist about that.
 
DesertMedic66 said:
Hahahaha. It is rare? It might be in the system you are in however it is not rare in the system I am in. Rolling up to frequent flyer Susan who is standing curbside with luggage saying “I’m gonna die, I need to go to the hospital now” is a normal occurrence.

And no thanks. I gave up my smoking habit several years ago.
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********
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So... Frank Esquire just quoted himself twice calling bull on his own posts... and given the overall demeanor of his posts here and other threads, I'm feeling like maybe they're making an attempt at using multiple profiles but failed to actually log out of the Esquire one first...
 
So I think what you are trying to say is:

“hey guys I had a 70 something year old male patient who is a resident at a SNF. The staff called us out because *im assuming syncopal episodes or lightheadedness*. He is alert and oriented x 3/4 *which ever your local system uses* with a GCS of 15. While laying supine he is complaint free and has a BP of 80/60 with a heart rate of 140 either A-fib or A-flutter, I wasn’t able to differentiate, with a respiratory rate of 16 and an SpO2 of 100% on room air with rales in *insert lung field here*. Patient/staff state he has a history of CHF but no other history is immediately available. Upon sitting the patient up he *once again I’m assuming he became lightheaded*. What would your treatment plan be?”

That paints a much better picture for anyone who is not able to see the patient and doesn’t know any of the specifics about your patient interaction.
 
DesertMedic66 said:
So I think what you are trying to say is:

“hey guys I had a 70 something year old male patient who is a resident at a SNF. The staff called us out because *im assuming syncopal episodes or lightheadedness*. He is alert and oriented x 3/4 *which ever your local system uses* with a GCS of 15. While laying supine he is complaint free and has a BP of 80/60 with a heart rate of 140 either A-fib or A-flutter, I wasn’t able to differentiate, with a respiratory rate of 16 and an SpO2 of 100% on room air with rales in *insert lung field here*. Patient/staff state he has a history of CHF but no other history is immediately available. Upon sitting the patient up he *once again I’m assuming he became lightheaded*. What would your treatment plan be?”

That paints a much better picture for anyone who is not able to see the patient and doesn’t know any of the specifics about your patient interaction.
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Jim37F said:
So... Frank Esquire just quoted himself twice calling bull on his own posts... and given the overall demeanor of his posts here and other threads, I'm feeling like maybe they're making an attempt at using multiple profiles but failed to actually log out of the Esquire one first...
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Frank frankerson ESQ said:
Whats the plan?
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Well since you have been saying this patient is going to die in a matter of seconds the only answer is to cardiovert them per AHA ACLS guidelines. Personally I would get a good assessment and R/O other causes and get a 12-lead and get a line. See if there have been any changes there. If there hasn’t been then I would likely give 0.25mg/kg of Dilt and then reassess.
 
Patients in cardiogenic shock. Bilateral rales. CHF, low BP. Cant get a line. Irregular narrow complex tachycardia that changes to regular and back again. Fluid no. Even if septic. I forgot hx of afib which likely wont respond to cardioversion, not a good spot. Positionally unstable. Tachy so push dose isnt awesome but an option, IO, decline=pads then cardiovert. I apologize for some of the remarks, felt like some people have 20 mins for an assessment.
 
Frank frankerson ESQ said:
Patients in cardiogenic shock. Bilateral rales. CHF, low BP. Cant get a line. Irregular narrow complex tachycardia that changes to regular and back again. Fluid no. Even if septic. I forgot hx of afib which likely wont respond to cardioversion, not a good spot. Positionally unstable. Tachy so push dose isnt awesome but an option, IO, decline=pads then cardiovert. I apologize for some of the remarks, felt like some people have 20 mins for an assessment.
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I'm going to consolidate LOTS of your posts...
Frank frankerson ESQ said:
CHF. 70 something.. 80/40. RR 16. Sat100. Cough. Rales bilateral, RVR afib/RVR aflutter here and there. Rate 140 Here And There. Skin so what Mental status ok when laying flat. No chief complaint.
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Frank frankerson ESQ said:
Patients in cardiogenic shock. Bilateral rales. CHF, low BP. Cant get a line. Irregular narrow complex tachycardia that changes to regular and back again. Fluid no. Even if septic. I forgot hx of afib which likely wont respond to cardioversion, not a good spot. Positionally unstable. Tachy so push dose isnt awesome but an option, IO, decline=pads then cardiovert. I apologize for some of the remarks, felt like some people have 20 mins for an assessment.
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You still have left a LOT out. Certainly you haven't still provided skin signs. You haven't characterized the cough. Is the "CHF" part of the history gathering or is it something you're initially assuming? What I'm seeing from the info you have provided is that you're looking at an unstable-ish tachyarrythmia. You're saying "cardiogenic shock" but there's not enough info from your presentation to say the tachyarrythmia is from some other cause. You're saying we have but 15 seconds to figure this out, but to gather this info, far more than 15 seconds has passed.

Still, you claim you're unable to get a line, you're "not awesome" for a push dose (of what?), and you think cardioversion isn't necessary (and likely won't respond). Since you (later) also state you don't have dilt, what meds do you have on hand?

Mind you, I had a patient a couple nights ago in my ED that had nearly an identical presentation for what you're apparently looking for if you walked up to the room at the right time.

Here's my take on this: if you have 15 seconds before this patient declines, then your patient is by definition extremely unstable and if you're thinking this is a "rate" problem then your fastest option is to go to synch cardioversion. Since the patient is "OK" when supine, I'm not convinced that we have to go to that and we have more than 15 seconds to figure this out. Knowing what limitations there are (like no dilt) may change a specific treatment plan. If you do not list our limitations, we'll assume we have access to EVERYTHING in our protocols.
 
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