PCP - Final Testing
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firetender
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That WAS PCP as in the drug PCP, yes?
If pts' not violent and amenable to it, or restrained properly and safely, Paper bag over the nose and mouth. Re-breathe to raise the CO2 level will lower resp. rate and BP and slow him down.
OOPS! now I see PCP is some sort of class or Canadian classification for medic.
. Still, the rapid resp. rate does indicate chest pain and BP is from an anxiety response leading to an OD on oxygen.
If pts' not violent and amenable to it, or restrained properly and safely, Paper bag over the nose and mouth. Re-breathe to raise the CO2 level will lower resp. rate and BP and slow him down.
OOPS! now I see PCP is some sort of class or Canadian classification for medic.
. Still, the rapid resp. rate does indicate chest pain and BP is from an anxiety response leading to an OD on oxygen.
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BossyCow
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OD on Oxygen with a Sat rate of 88%? Most of the anxiety pt's I see sat at 99 - 100
Agreed. That's a new one for me too, especially on 21% (room air).
Blowing off CO2 is another different mechanism.
If someone is in pain, especially CP, there's PAIN, fear, denial and anxiety. I would treat the CP and not worry about " blowing off or having them rebreathe CO2". They are already with SpO2 of 88%. A paper bag will only exacerbate that.
If the patient is ventilating well on their own even with higher than text book norms, I would let them manage their own venitlations. Now if you are talking the possibility of CPAP and not PPV if there is increased WOB due to a CHF component, then that is a different avenue to explore.
Of course, when it comes to test taking, what is your text book/instructor telling you?
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Sorry folks... PCP is Primary Care Paramedic in Ontario.
The instructor is telling us to bag this pt. I failed the sceneario for treating the CP and rapid transport, 1 x nitro and 1 x asa, then pt. codes and I followed the non-trauma defib protocol (4 analysis w/ cpr and transport). Didn't feel the sat level was accurate, pt was hyperventalating considered that to be normal with CP.
The instructor is telling us to bag this pt. I failed the sceneario for treating the CP and rapid transport, 1 x nitro and 1 x asa, then pt. codes and I followed the non-trauma defib protocol (4 analysis w/ cpr and transport). Didn't feel the sat level was accurate, pt was hyperventalating considered that to be normal with CP.
I don't feel this pt was hyperventilating at all. The tidal volume was inadequate due to pain when inhaling. Rate was increased because of the increasing hypoxic state. On O2 by NRB and some coaching this pt could have turned around, but it could have delayed more appropriate treatment.
As for bagging... Any time the breathing is inadequate for any reason (rate, tidal volume) then the pt needs PPV.
I suppose there are two schools of thought when the pt is on the boarderline. Coaching to bring the rate and tidal volume into normal ranges, or immediately bag them. Local protocols may alter your actions.
Asclepius
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Sounds to me like it could be a PE.
Hyperventilation can only be diagnosed with an Arterial Blood Gas. Tachypnea is the correct terminology. A RR of 28 is not that bad. However, without knowing the size of the pt (obesity) or depth and quality of the respirations the patient could actually be retaining CO2 or have poor cardiac output(increasing metabolic acidosis) which the increased RR may be to maintain a pH compatible with life.
Jumping to conclusions before all of the assessment is done can skew the rest of the exam. Treat the symptoms to see what the response is and go from there.
PPV, if the pt's effort and quality of respirations are failing, the yes. You may not be able to do PPV as effectively as the pt is when it comes to maintaining a body's homeostasis. You also may have to bag at a rate of 28 or higher until you can adjust the depth of the ventilation to even out the required minute volume.
Jumping to conclusions before all of the assessment is done can skew the rest of the exam. Treat the symptoms to see what the response is and go from there.
PPV, if the pt's effort and quality of respirations are failing, the yes. You may not be able to do PPV as effectively as the pt is when it comes to maintaining a body's homeostasis. You also may have to bag at a rate of 28 or higher until you can adjust the depth of the ventilation to even out the required minute volume.
Asclepius
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This is very true. However, sometimes you have to form a differential diagnosis with the limited information you have. The tachypnea with the low spo2 could be a recipe for a PE. Could be many other things as well. I had a patient like this not long ago. PE never crossed my mind, but later I followed up and that's what it was.
And now PE will stick in your mind.
There are about 102 other diagnosis that can fit the same recipe. I've got 15 different ones today on my service complete ABGs with a wide range of PaCO2s, RRs in the 30s or 40s, SpO2s all over the map and a variety of pulmonary, GI, neuro and cardiac diseases. But, then, keepin' them breathin' is my specialty. It's just when every other system begs for attention also, you have to focus on the whole body. None of these patients fit nicely into just one line on the care plan. If would be great if everything did fit into those few diseases learned in the paramedic text.
Asclepius
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Agreed. My only point was that you make the best diagnosis with what information you have until you can learn more. As I said, could be many other things.