Noob indeed, lol, one of the things I learned In Emt school which appliend in this situation is ... we are looking to much for signs and vitals missing the obvious picture ... anywho, pt has dementia so level of orientation is not relevant, pt. With dementia are frequently disoriented, Or have periods of different orientation (havent you seen "the notebook" chick flick) making it a weak indicator of hypoxia, however it is good to know that she is alert (avpu: alert to verbal/pain)
It's great that you recognized that she is sick lol, of what, if I may ask?, but first things first ... SCENE SAFETY (Penman) , personal partner patient safety (there was a dog at residence) environmental hazard (non), mechanism of injury (moi: pt woke up with sharp sudden pain on left arm, non trauma), additional resources (non at the moment) number of patient (1), need for c-spine (negative since it was non traumatic)
The Cincinnati coma scale will just tell you that she has had a stroke in the past, she has left limb weakness from prior stroke making her unable to pick up left arm, plus dementia causes them to say odd things, and prior cva also caused facial droop, so Cincinnati coma scale tool went out the door , AND family member says that she is normally that way
Bed ridden, you tell me (hint she has left extremity weakness, meaning there is little to non left extremity movement)
Oxygen is always a good form to relief anxiety/distress AS LONG as their CONDITION DOES NOT INCLUDE HYPOXIC DRIVE (what are the Contra indication of supplemental O2?)
And as for ekg leads, it would be great if als was around BUT he isn't you are a BLS unit (unit with Emt-B w/o medic) but on that note, when should you call for als?
Give it another poke your on the right track
I was half asleep before, fully awake here goes:
Since this was a scenario I didn't do all the scene safety stuff we did in class. I treated this like a real call, not a class. I don't walk into my scenes saying "BSI, is my Scene Safe?" Yes, I take it seriously, I just don't verbalize it. Patients would probably give us strange looks if we did.
I have yet to perform a F.A.S.T. test in the field, but it is my understanding that it is an indicator of a possible stroke. Not a past stroke. While it is possible that a patient may still exhibit some signs from the previous stroke I doubt all the signs would be there. Family should also be able to tell you if something is normal for that patient or not.
I am aware of the Hx of Dementia, however that doesn't change the fact that I am going to do an A&O questions. How severe is her Dementia? Are her answers consistent with her dementia based on family. What is my gut feeling based on seeing this patient on her level of Dementia? Do I think her answers are Dementia related or am I thinking her lack of awareness is something else based on what I am seeing?
Is her A&O altered because of the dementia, or because of the Lidocaine Patch? Confusion and altered mental status can be a side effect of the patch. Again, need family to tell you what is normal for this patient.
You gave no indication of if she was bed ridden or not. However, I doubt you would post this if she was a minor dementia case so I will assume she is bed ridden due to the Hx of dementia, and CVA. How long ago was the skull fracture? What caused her to fall and any other injuries associated with it?
Based on her A&O and Dementia, how do I know this patient is in pain? Guarding? Reaction to touching or moving the arm? Any signs of bed sores?
There is a lot that can be going on with this patient. Arm pain from laying on it to long (I would think that would be gradual onset though). Possible closed fx, etc.
Does she experience any relief when I move her arm? I may or may not stabilize her arm with a sling and swathe, depending on if I feel it would be of benefit in this patient. Based on what you have said, I doubt stabilizing would be a benefit, but I am going to consider it.
Do I see any discoloration distal to the site of pain? Arm is swollen, is the edema below the site of pain?
Interview time SAMPLE / OPQRST questions. I want to ask BOTH the patient (yes I know she is A&O x 1 but I want to see how she responds if at all) and the family.
My initial concern is still an embolism secondary to being in a sedentary position. I am going to package her up in position of comfort and were going to the hospital. I still don't think ALS is prudent in this call. She has several risk factors to develop embolism: Dementia, hx of cva, lack of physical movement, etc.
I don't give o2 to every patient. If your breathing adequately on 21% o2, why should I give 100%? No I won't withhold oxygen but I don't see any reason to give it to her. Further, I would be worried that with her dementia she might freak out seeing the mask. If I did give her o2 it would be via NC at 2-4 lpm. I don't typically give o2 just to relax a patient. I can do that by communication. If a patient needs o2 they will get it based on Signs and Symptoms.
While she appears stable, I am probably going to re-evaluate her closer to the 5 minute mark rather than every 15 mins. Her age, history, and presenting issue make her potentially unstable. Geriatric patients can decompensate rapidly. I would be prepared to address any complications enroute to hospital.
I don't treat numbers, I treat the patient. Numbers are important though and from initial reading they seem remarkably good. Any change in vitals since first set?
- strikes me as odd for some reason)