1. Tired of seeing ads? Click here to register today and the ads go away. It's completely FREE, too!
    Dismiss Notice
  2. Can't find what you're looking for? Use the search bar in the upper right corner.
    Dismiss Notice

Scenario - For students

Discussion in 'Scenarios' started by NomadicMedic, May 6, 2017.

  1. AcuteBlueWaffle

    AcuteBlueWaffle Forum Ride Along

    4
    2
    3
    Education:
    Student
    Excuse me for my probably under-educated response, but i'm going to take a stab at it

    She's clearly having a sympathetic response.
    BP? pain? BGL? Does/has she felt weak/sick at all? LOC?

    1. PE (sudden onset, low O2, tachypnea/tachycardia BUT no cyanosis?)
    2. MI (sudden onset, low O2, pale, cool, clammy, tachypnea/tachycardia, >40 age)
    3. Some sort of internal bleeding. curious to see further assessment

    I'd put on a 15lpm NRB and GO
     
    NomadicMedic and VentMonkey like this.
  2. VentMonkey

    VentMonkey Crackpot Premium Member

    3,944
    3,114
    113
    Education:
    Paramedic
    IMG_0353.JPG
     
    ERDoc and AcuteBlueWaffle like this.
  3. AcuteBlueWaffle

    AcuteBlueWaffle Forum Ride Along

    4
    2
    3
    Education:
    Student
    After I slept on it, I'm thinking MI.

    1) She's in cardiogenic shock and can't pump well enough peripherally, thus causing the increased cap refill.
    2) The sympathetic NS is activated with her lack of oxygen to her heart.
    3) women tend to have more "silent" MIs and she might not have pain per say, but will feel have N/V or just a general weakness.
    4) it was sudden and unprevoked

    Also, along with high flow O2, I'm giving 324 my of aspirin to help with platelets not clotting as well
     
  4. Chase

    Chase Flight Nurse

    3,046
    647
    113
    Education:
    EMT
    Can patients with PE go into shock? What kind?
     
    NomadicMedic likes this.
  5. AcuteBlueWaffle

    AcuteBlueWaffle Forum Ride Along

    4
    2
    3
    Education:
    Student
    Obstructive shock.
    But what I'm confused about is normally (i thought), patients get cyanosis because they aren't getting oxygen rich blood in PEs because of the obstruction.

    I guess I just need help with how to distinguish which route to go. Other than rales/crackles in the lungs (PE), don't PEs and MIs have very very similar presentations?

    Also, I'm treating the patient with blankets to keep warm
     
  6. NomadicMedic

    NomadicMedic formerly DEmedic

    10,103
    4,450
    113
    Education:
    Paramedic
    I love that @Chase is kicking in some stuff here.

    Here's a few more tidbits for you.

    She's fully conscious and alert, but incredibly anxious, says she's complaining of chest tightness. This is very obviously not a hypoglycemia scenario, but for those who want to blood sugar, it is 98.

    On a NRB at 15lpm her SpO2 is 99%. Respiratory rate is still around 40, etCO2 is still 12. Capnography waveform is non obstructed.
     
  7. AcuteBlueWaffle

    AcuteBlueWaffle Forum Ride Along

    4
    2
    3
    Education:
    Student
    Ok, my best educated guess is an MI with until convinced otherwise.

    Out of curiosity, what does the ETCO2 below the average (35-45) mean? I can't seem to figure it out.

    Did she change in appearance with the o2?
     
  8. CWATT

    CWATT Forum Lieutenant

    105
    25
    28
    Education:
    EMT
    I figured out my error -

    "End tidal partial pressure of CO2 (ETCO2) is a physiological surrogate for vascular obstruction from PE. Pulmonary thromboembolism results in dead space ventilation and therefore prevents meaningful gas exchange in the subtended lung unit, yielding an alveolar CO2 content as low as zero mmHg. As a result, carbon dioxide content measured at end expiration, which represents admixture of all alveolar gas, drops in proportion to dead space ventilation"

    http://erj.ersjournals.com/content/erj/early/2009/08/28/09031936.00084709.full.pdf
     
    Chase likes this.
  9. Chase

    Chase Flight Nurse

    3,046
    647
    113
    Education:
    EMT
    Awesome job doing the research to find the answer. ETCO2 is huge topic itself but it's important to remember that it is just as much a marker of perfusion as it is ventilation. Don't get caught chasing the number trying to correct it thinking it's a ventilation issue as your patient is circling the drain.

    I remember coding a young woman who suddenly collapsed without notice (smoker/obese/birth control) and going through multiple colorimetric and waveform ETCO2 devices trying to confirm the ET tube but not getting any results, knowing it placed correctly . Turned out she had a massive totally occlusive saddle PE.
     
    CodeBru1984, CWATT and NomadicMedic like this.
  10. CALEMT

    CALEMT The Other Guy

    2,951
    1,985
    113
    Education:
    EMT
    Inadequate ventilation. A low capnography reading indicates hyperventilation and the blowing off of CO2 causing a homeostasis to be out of whack. Low CO2 readings are indications of the body becoming alkalotic because CO2 is acidic in nature. Take the acid away and the blood will become more basic. Same concept works vice versa. Hypoventilation (high capnography readings) indicates CO2 retention which in return blood will be more acidotic.
     
    AcuteBlueWaffle likes this.
  11. captaindepth

    captaindepth Forum Lieutenant

    128
    52
    28
    Education:
    Paramedic
    *Inadequate respiration** ..... for this case.

    Ventilation is just the movement of gasses in and out of the lungs, respiration is the actual gas exchange (O2 and CO2) of said gasses moving in and out of the lungs. P.E. is a great example of this. Lung sounds are clear with good movement of air throughout all fields but a low SpO2 and ETCO2 due to the decrease in perfusion and ability for gas exchange.
     
  12. Tigger

    Tigger Dodges Pucks Community Leader

    6,255
    1,625
    113
    Education:
    Paramedic
    I think promptly ruling out hyperglycemia with tachypneic patients is still a good idea, though her mentation makes this less likely.
     
  13. Old Tracker

    Old Tracker Forum Captain

    283
    139
    43
    Education:
    EMT
    Great thread. I just learned a metric ton of good stuff.
     
  14. ParkMedic

    ParkMedic Forum Probie

    21
    7
    3
    Education:
    EMT
    Mas! Mas! Por favor.
     
  15. E tank

    E tank Forum Captain

    433
    318
    63
    Or a drastically reduced amount of blood (read: CO2) making it thru the lungs...
     
    NomadicMedic and DesertMedic66 like this.
  16. Jackson dunn

    Jackson dunn Forum Ride Along

    6
    0
    1
    Education:
    Student
    I'm new. Sounds like respiratory failure to me. High flow oxygen via bvm?


    Sent from my iPhone using Tapatalk
     
  17. StCEMT

    StCEMT Forum Deputy Chief

    1,809
    990
    113
    Education:
    Paramedic
    Respiratory failure caused by what? (This is just to brainstorm ideas based on what you see)
     
    Jackson dunn and NomadicMedic like this.
  18. Jackson dunn

    Jackson dunn Forum Ride Along

    6
    0
    1
    Education:
    Student
    Explain please!


    Sent from my iPhone using Tapatalk
     
  19. NomadicMedic

    NomadicMedic formerly DEmedic

    10,103
    4,450
    113
    Education:
    Paramedic
    Why is this patient experiencing shortness of breath? Is A BVM the right choice?
     
    Jackson dunn likes this.
  20. Jackson dunn

    Jackson dunn Forum Ride Along

    6
    0
    1
    Education:
    Student
    Thanks. Makes sense now.


    Sent from my iPhone using Tapatalk
     

Share This Page