DrankTheKoolaid
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Had an interesting call recently. Get called for unknown medical. Arrive on scene and receive report from patient spouse in driveway before entering residence that patient 60's YO F with a history of cervical CA and a recent Paracentesis (first incident of abdominal distention) drawing 3L off 5 days prior to my contact with her. Spouse relates patient increasingly weaker and has not eaten for 4 days, including the last 2 days while admitted.
Meds : Tinture of Opium, Omeprazole, Synthroid
Alleriges : None
PMH : Cervical CA, Chronic Colitis, G.E.R.D., Hypothyroidism with thyroid still in place
Patient who appears emaciated with a stated in hospital weight of 42kg at discharge, found inside residence. Patient is pale cool and dry, with slow but appropriate responses which is not her norm as I've known this woman for 15+ year. Patient states has had nausea non stop for the last 4 days without vomiting, but has decreased her appetite to nothing. Patient states attempted to drink juices but due to her chronic colitis the acidity of the juices does not sit well with her so she has been on a water diet.
PX includes purple colored hands cap refill 2 seconds with immediate blood produced from lancet use and feet with lower extremities with venous stasis ulcers (weeping) wrapped in ace wraps (when asked about Una's boots states they were removed 2 weeks ago and replaced with the ace wraps). Bruising noted all up and down arms from In-hospital IV attempts. hypertensive 140's/90's tachy at 110 ST without ectopy, 12 unlabored lungs clear unable to obtain accurate O2 sat, Tympanic temp 96.8 12 lead shows same.
Patient unable to even get into a standing position on her own. Once in truck en route 1h 15m to ED. IV 22ga (lucky to find that) with a BG of LO with 25g dextrose administered. 5 minutes pass and patient relates nausea is now gone. Patient remained pale cool and dry and slow to respond. Second BGL reading LO. 2nd 25g dextrose administered 5 minutes pass with patient global color is improving and speech is beginning to improve wait 10 minutes and recheck glucose. Reading LO. At this point i'm thinking there has to be a equipment malfunction so I test my own, (90 mg/dL) Post Mocha so feeling pretty good about that fyi, and test solution 277 mg/dL so machine is working as intended. Patient receives 3rd 25g dextrose, now sitting upright eyes remaining open and conversing as normal. Just prior to arrival at ED patient color noted decreasing back to pale. Report to ED staff which I get funny looks from the RNs accepting patient into a far corner room. Remained in room to see what ED staff obtained after 3 amps of dextrose. (F)BGL 20 mg/dL. RN no longer make eye contact with me and quickly move her front and center to the nurses station.
With the given history and medications. Whats everyone think about the glucose utilization here. I'll hopefully follow up with the PLN later this afternoon to see what they came up with.
3 amps is a first for me, and to see a 20 glucose afterwards is just baffling
Meds : Tinture of Opium, Omeprazole, Synthroid
Alleriges : None
PMH : Cervical CA, Chronic Colitis, G.E.R.D., Hypothyroidism with thyroid still in place
Patient who appears emaciated with a stated in hospital weight of 42kg at discharge, found inside residence. Patient is pale cool and dry, with slow but appropriate responses which is not her norm as I've known this woman for 15+ year. Patient states has had nausea non stop for the last 4 days without vomiting, but has decreased her appetite to nothing. Patient states attempted to drink juices but due to her chronic colitis the acidity of the juices does not sit well with her so she has been on a water diet.
PX includes purple colored hands cap refill 2 seconds with immediate blood produced from lancet use and feet with lower extremities with venous stasis ulcers (weeping) wrapped in ace wraps (when asked about Una's boots states they were removed 2 weeks ago and replaced with the ace wraps). Bruising noted all up and down arms from In-hospital IV attempts. hypertensive 140's/90's tachy at 110 ST without ectopy, 12 unlabored lungs clear unable to obtain accurate O2 sat, Tympanic temp 96.8 12 lead shows same.
Patient unable to even get into a standing position on her own. Once in truck en route 1h 15m to ED. IV 22ga (lucky to find that) with a BG of LO with 25g dextrose administered. 5 minutes pass and patient relates nausea is now gone. Patient remained pale cool and dry and slow to respond. Second BGL reading LO. 2nd 25g dextrose administered 5 minutes pass with patient global color is improving and speech is beginning to improve wait 10 minutes and recheck glucose. Reading LO. At this point i'm thinking there has to be a equipment malfunction so I test my own, (90 mg/dL) Post Mocha so feeling pretty good about that fyi, and test solution 277 mg/dL so machine is working as intended. Patient receives 3rd 25g dextrose, now sitting upright eyes remaining open and conversing as normal. Just prior to arrival at ED patient color noted decreasing back to pale. Report to ED staff which I get funny looks from the RNs accepting patient into a far corner room. Remained in room to see what ED staff obtained after 3 amps of dextrose. (F)BGL 20 mg/dL. RN no longer make eye contact with me and quickly move her front and center to the nurses station.
With the given history and medications. Whats everyone think about the glucose utilization here. I'll hopefully follow up with the PLN later this afternoon to see what they came up with.
3 amps is a first for me, and to see a 20 glucose afterwards is just baffling
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