LACoGurneyjockey
Forum Asst. Chief
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You respond code 3 for difficulty breathing to find a 71 year old male sitting in his recliner at home. The patients daughter meets you at the door to tell you her father can't breath and is extremely weak. She came to check on him this morning after he hasn't been feeling well for 2 days. When she tried to get him out of bed, he defecated on himself and was unable to support his own weight. She dragged him out to the living room recliner where you find him. She says he has diabetes, high blood pressure, and hyperthyroidism.
The patient states he feels mostly fine, just can't catch his breath. He tells you this is just because of the heat, and repeats that he is fine. It is a comfortable room temperature inside, and about 70-80 degrees outside. He is oriented but slow to respond, and whispers very quietly whenever he speaks, which per the daughter is not his normal. You notice he is breathing about 40/min and shallow. He is extremely pale, with cool moist skin. He consents to treatment and you obtain vital signs. His blood pressure is 154/92, pulse is 70 and irregular, and spo2 is 95% on room air. Blood glucose is 128 and he shows a-fib on the monitor. He denies any history of a-fib or any cardiac hx. A 12 lead is attached.
What more would you like to know about his history? What are your priorities of treatments, if any? You have an 8 bed community hospital with very limited capability 5-10min away, and a large trauma/stemi/stroke capable hospital a little over an hour away. What's your destination decision and why? What's your differential diagnosis?
The patient states he feels mostly fine, just can't catch his breath. He tells you this is just because of the heat, and repeats that he is fine. It is a comfortable room temperature inside, and about 70-80 degrees outside. He is oriented but slow to respond, and whispers very quietly whenever he speaks, which per the daughter is not his normal. You notice he is breathing about 40/min and shallow. He is extremely pale, with cool moist skin. He consents to treatment and you obtain vital signs. His blood pressure is 154/92, pulse is 70 and irregular, and spo2 is 95% on room air. Blood glucose is 128 and he shows a-fib on the monitor. He denies any history of a-fib or any cardiac hx. A 12 lead is attached.
What more would you like to know about his history? What are your priorities of treatments, if any? You have an 8 bed community hospital with very limited capability 5-10min away, and a large trauma/stemi/stroke capable hospital a little over an hour away. What's your destination decision and why? What's your differential diagnosis?