Epi-do
I see dead people
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We were dispatched to a sick person and arrived to find an 86yo female sitting near the front door. She said she was having "kidney pain" and when asked to show us where the pain was, she pointed to her lower back. She mentioned she had part of one of her kidneys removed and the pain she was having was similar to what she had at that time. She also told us that she had been up all night with frequent urination. Denied a fever, pain or burning upon urination, and said it didn't feel as if she had a UTI. We grab her bag of meds, get her on our cot and head to the hospital. Our scene time was probably less than 5 minutes.
Once in the truck, I get a set of vitals. Her BP is 218/110. She hasn't been very forthcoming about her history, but does admit having htn. She is on 3 or 4 different meds for it, but didn't take any of them because she wasn't feeling well. She asks what her BP was and when I tell her, she says it has been alot higher than that in the past and denies having a headache, dizziness, or any other symptons that may be caused by the elevated BP. I went ahead and put her on O2 (4lpm, n/c) and we continue on our way. My gut told me I should have started a medic at that time, but I decided not too. Our protocols state that we must request ALS for abnormal VS only if the patient is symptomatic, and since she wasn't, I went against my gut feeling. The rest of her vitals were pulse 104, resp 18, skin pale, warm and dry. Breath sounds were clear and equal.
I went through the rest of her meds, tried to get more of a history from her (which wasn't successful since "the hospital has my records"), and continued to reassess her. Second set of vitals was BP 182/100, pulse 92, resp 16, skin still pale, warm and dry. Breath sounds were also unchanged.
At this time, the patient begins complaining that she is nauseous and dizzy. I lay her back a little bit (she didn't want to lay down at all, prefered to be sitting upright) and gave her an emisis basin, just in case. She then starts rubbing her chest and says that she thinks her stomach is starting to bother her. When I question her about it, she says she feels as if there is a pressure on her chest, like someone is sitting on it. She also decides to add that she does have some heart problems, which I already suspected since she is on nitro. I request a medic and am told they can have one meet me at the hospital. Ummm....no thanks. We aren't that far from the hospital at this point so I just have my partner light things up and we go in emergent the rest of the way. I then followed our BLS protoclos for chest pain.....O2 (which she was already on), 162 mg of baby asprin, and we can assist the patient with their own nitro. Well, wouldn't you know it, even though nitro is on her list inside the med bag, the actual bottle of the stuff isn't in there. Not a huge deal, I guess, since at that point we were pulling into the bay at the ER.
I didn't get to see her 12 lead before leaving the ER, but the 4-lead was NSR.
So, my question is, would anyone have done anything differently? Do you think she was actually having a cardiac event along with whatever else she had going on, or was it probably not cardiac in nature and something related to the original complaint she had of "kidney pain"?
Once in the truck, I get a set of vitals. Her BP is 218/110. She hasn't been very forthcoming about her history, but does admit having htn. She is on 3 or 4 different meds for it, but didn't take any of them because she wasn't feeling well. She asks what her BP was and when I tell her, she says it has been alot higher than that in the past and denies having a headache, dizziness, or any other symptons that may be caused by the elevated BP. I went ahead and put her on O2 (4lpm, n/c) and we continue on our way. My gut told me I should have started a medic at that time, but I decided not too. Our protocols state that we must request ALS for abnormal VS only if the patient is symptomatic, and since she wasn't, I went against my gut feeling. The rest of her vitals were pulse 104, resp 18, skin pale, warm and dry. Breath sounds were clear and equal.
I went through the rest of her meds, tried to get more of a history from her (which wasn't successful since "the hospital has my records"), and continued to reassess her. Second set of vitals was BP 182/100, pulse 92, resp 16, skin still pale, warm and dry. Breath sounds were also unchanged.
At this time, the patient begins complaining that she is nauseous and dizzy. I lay her back a little bit (she didn't want to lay down at all, prefered to be sitting upright) and gave her an emisis basin, just in case. She then starts rubbing her chest and says that she thinks her stomach is starting to bother her. When I question her about it, she says she feels as if there is a pressure on her chest, like someone is sitting on it. She also decides to add that she does have some heart problems, which I already suspected since she is on nitro. I request a medic and am told they can have one meet me at the hospital. Ummm....no thanks. We aren't that far from the hospital at this point so I just have my partner light things up and we go in emergent the rest of the way. I then followed our BLS protoclos for chest pain.....O2 (which she was already on), 162 mg of baby asprin, and we can assist the patient with their own nitro. Well, wouldn't you know it, even though nitro is on her list inside the med bag, the actual bottle of the stuff isn't in there. Not a huge deal, I guess, since at that point we were pulling into the bay at the ER.
I didn't get to see her 12 lead before leaving the ER, but the 4-lead was NSR.
So, my question is, would anyone have done anything differently? Do you think she was actually having a cardiac event along with whatever else she had going on, or was it probably not cardiac in nature and something related to the original complaint she had of "kidney pain"?
h34r:
