Epi-do
I see dead people
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Dispatched for chest pain, arrive to find 84yoWF laying in bed, complaining of L&RUQ abdominal pain that comes and goes. Patient states symptoms originally began 2 days ago, with today's episode starting 45-60 minutes prior to calling 911. Pt. has a history of one similar episode happening one year prior, but did not seek treatment at that time.
She presents as A&Ox3, PERL, skin is pale, cool, and dry. She denies chest pain, difficulty breathing, vomitting. States she does feel nauseous and weak. Initial VS's are 182/98, HR 62, RR 16.
Pt is moved to a stair chair to get her to the lower level of the house. At that time she states she feels dizzy and nausea has gotten worse. Pt is transfered to cot and then to truck. Second set of VS: ~160/80 (I don't remember exactly), HR 58, RR 18, SpO2 97%. Pt. also states dizziness has gotten better now that she is laying down again. Pt. placed on O2 @ 4 lpm via NC.
Pt states only hx is htn and hypothyroidism. Meds include atenolol, simvastatin, lasix, atropine, and synthroid. When asked about shy she takes lasix and atropine, she insisted they were for her htn. Only allergy is sulfa.
The particular ER the patient wanted to go to wants a radio report for every single patient coming in by ambulance, so they were contacted and a report was given.
Pt reassessed. States pain and nausea are worse. Rates pain 9/10. Pain in LUQ increases with palpation. VS are now ~150/60, HR 50, RR18, SpO2 96% Skin is still pale, cool, dry although pt states she feels as if she is beginning to have a cold sweat. At this point we are only 1-2 minutes out from the hospital. Switch pt. over to NRB @ 15 lpm. Pt still denies CP, difficulty breathing, but begins to have dry heaves.
Literally, as we are pulling into the hospital, pt's HR drops to 42 for a few seconds and then comes right back up to 56. At this time, pt states she feels much more nauseous and begins to vomit again. (The vomitting came after the drop in heart rate, not before.)
Total transport time was 9 minutes and pt was transported BLS. A medic had been onscene with us and evaluated the pt, including putting her on the monitor. Nothing remarkable was noted on the monitor, and the medic, like myself, thought the pt would be ok going in BLS and that it didn't look like what was going on was cardiac in nature.
As we transported the patient and were almost to the hospital, I began to wonder if this was a cardiac event, just an atypical presentation of something. She never once complained of chest pain or pressure, just abdominal pain. I never requested another medic because I could get to the ER first.
Outside of the medic taking her in, is there anything else BLS-wise I could have done for her? What could have been done for her ALS outside of maybe putting in a line and having her on the monitor? I did talk to the two medics onstation about this run when we got back, but am just curious about what others think.
She presents as A&Ox3, PERL, skin is pale, cool, and dry. She denies chest pain, difficulty breathing, vomitting. States she does feel nauseous and weak. Initial VS's are 182/98, HR 62, RR 16.
Pt is moved to a stair chair to get her to the lower level of the house. At that time she states she feels dizzy and nausea has gotten worse. Pt is transfered to cot and then to truck. Second set of VS: ~160/80 (I don't remember exactly), HR 58, RR 18, SpO2 97%. Pt. also states dizziness has gotten better now that she is laying down again. Pt. placed on O2 @ 4 lpm via NC.
Pt states only hx is htn and hypothyroidism. Meds include atenolol, simvastatin, lasix, atropine, and synthroid. When asked about shy she takes lasix and atropine, she insisted they were for her htn. Only allergy is sulfa.
The particular ER the patient wanted to go to wants a radio report for every single patient coming in by ambulance, so they were contacted and a report was given.
Pt reassessed. States pain and nausea are worse. Rates pain 9/10. Pain in LUQ increases with palpation. VS are now ~150/60, HR 50, RR18, SpO2 96% Skin is still pale, cool, dry although pt states she feels as if she is beginning to have a cold sweat. At this point we are only 1-2 minutes out from the hospital. Switch pt. over to NRB @ 15 lpm. Pt still denies CP, difficulty breathing, but begins to have dry heaves.
Literally, as we are pulling into the hospital, pt's HR drops to 42 for a few seconds and then comes right back up to 56. At this time, pt states she feels much more nauseous and begins to vomit again. (The vomitting came after the drop in heart rate, not before.)
Total transport time was 9 minutes and pt was transported BLS. A medic had been onscene with us and evaluated the pt, including putting her on the monitor. Nothing remarkable was noted on the monitor, and the medic, like myself, thought the pt would be ok going in BLS and that it didn't look like what was going on was cardiac in nature.
As we transported the patient and were almost to the hospital, I began to wonder if this was a cardiac event, just an atypical presentation of something. She never once complained of chest pain or pressure, just abdominal pain. I never requested another medic because I could get to the ER first.
Outside of the medic taking her in, is there anything else BLS-wise I could have done for her? What could have been done for her ALS outside of maybe putting in a line and having her on the monitor? I did talk to the two medics onstation about this run when we got back, but am just curious about what others think.
