what do you think

[PArescueEMT]

You are dispatched to a residence for a "Respiratory Emergency" with ALS. It takes 6 mins to get the ambulance out the door. 1 EMT and 1 FR.
Dispatch Report : "56 y/o M c/o respiratory distress, and profuse sweating"
Arrival : mid 50's M tri-podding on couch, general pallor, wetter than the ocean. States he has been fishing all day, came home watched TV and started to have chest pain.
PMH: unremarkable
PSH: Herniated disk repair
Meds: Multi-vitamin daily
Ax: PCN

V/S:
Pulse: 88 and thready
Resp: 36 Labored
B/P: 100/90

Load and go or stay and play?

 

[PArescueEMT]

and what do you think is going on

more info to come as replys come in!!!!!!

 

[wolfwyndd]

Load and go or stay and play should be answered by arrival time of an ALS unit. What are his breath sounds like? That would also assist with deciding load and go or stay and play. Either way, this guy gets 15 LPM O2 via NRB whether ALS is enroute or not. Given the information available, I'm leaning toward MI. Assist patient with his own 325 mg of aspirin. With his BP I think we can rule out nitro.

 

[MICU]

First of all we talking chest pain so O2 first, then Aspirine 300mg chew, then ECG from there we go farther Isoket SL, Haprine IV, MO IV and so on so on.

but I dont have all that so O2 aspirine and speeding twards the ER

 

[KEVD18]

short term answer: stay and play
o2 15l nrb
asa per protocol
re assess vs in 5
get eta on als

als <5 wait
als >5 scoop and screw

v/s reassessment:
if bp increased, nitro if prescribed to pt of if it happens to be a bls med in your service(nitro indicated in pts c a systolic >100. it doesn't say how much over a hundred, just over)

if not, haul *** to er and intercept en route

my diff dx is pretty much the same as everyone else. ami. now since you brought this case study to our attention, its either not what we would expect, or your seeking justification for your tx. im going with unusual dx on this one although i don't have the faintest clue...

 

[jeepmedic]

First of all:

It takes 6 mins to get the ambulance out the door.

This needs to be fixed.

2ed. How long ago was the back Surg.? Could be P.E.

What are Lung sounds?

O2 15 lpm via NRB, follow Protocal here would be ASA 3 81mg chewable, If ALS not on scene then transport meet ALS in route if they are behind you then you transport. Call med control and give 0.4mg NTG SL.

 

[Jon]

Well... Welcome Back, Zak

That would be a load and go, espicially with your usually extended ETA's to the ED. Meet with ALS enroute.

Given that the patient seems to present in acute respiratory distress, as well as chest pain... he is possibly having an MI, but it could be any number of other things. What do lungs sound like?

 

[KEVD18]

wasnt going to bring up the dissapointing chute time, but since the doors been opened:

is this a call dept with crew responding from home or a manned station?

if a call dept, thats actually quite good

for a manned station: 6 min...holy mary mother of god!!!!! ive seen better chute times from horse drawn ambulance.

my co has a two minute standard for emergent calls and 4 for nonemergent

 

[Airwaygoddess]

Load and go, Hi flow O2 via NRB mask freq. V.S. put the pt. in POC. get SAMPLE hx, request ALS intercept for advanced care. Sounds pretty cardiac, or pulmonary to me!

 

[Jon]

and what do you think is going on

more info to come as replys come in!!!!!!

So.. where is it?

 

[wolfwyndd]

Call med control and give 0.4mg NTG SL.

.04 mg of NTG is not indicated in this instance. BP is BORDERLINE and noting the surgery and shortness of breath, I wouldn't do it. He also hasn't been perscribed NTG either. Another no no. Depending on your jurisdiction, MC MIGHT allow it, but I won't waste the time contacting them unless you've got a 20 minute or more transport time.

 

[PArescueEMT]

als arrives as the pt is being loaded in the rig. als starts CP protocall and monitor shows sinus tach. Approx 5 mins into transport, pt codes with v- tach on the monitor. 1 round of CPR and 1 shock later, pt is appologizing for falling asleep. 4 weeks later, i run into pt who told me that he had an anterior wall and an inferior wall MI at the same time. with the down time being almost non-existent, Pt has no ischemia orother deficit.

 

[Flight-LP]

.04 mg of NTG is not indicated in this instance. BP is BORDERLINE and noting the surgery and shortness of breath, I wouldn't do it. He also hasn't been perscribed NTG either. Another no no. Depending on your jurisdiction, MC MIGHT allow it, but I won't waste the time contacting them unless you've got a 20 minute or more transport time.

Nitroglycerin is absolutely indicated. Chest Pain, Acute Pulmonary Edema, both are treated with NTG as the first line treatment. A BP of 100/90 equals an approximate mean arterial pressure of 93, well above the recommended minimum pressure. This pt. needed NTG, preferably a NTG drip..............

 

[FFEMT1764]

Nitroglycerin is absolutely indicated. Chest Pain, Acute Pulmonary Edema, both are treated with NTG as the first line treatment. A BP of 100/90 equals an approximate mean arterial pressure of 93, well above the recommended minimum pressure. This pt. needed NTG, preferably a NTG drip..............

Followed by morphine, and if approved for use in your area CPAP would hurt to try either, at least in the begining, after 5 miuntes of CPAP if they arent better then its time for NTG, morphine, and lasix, along with a very quick trip to the ER

 

[BossyCow]

'Wetter than the ocean' means sweating bullets or that horrible wet, gurgling breathing noise of a CHF pt.

I would try to determine if the chest pain is cardiac and the cause of the resp. issues or musc/skeletal and a red herring.

Had he ingested anything strange while out fishing?

I'm nervous around anyone with that kind of respiratory distress. I've seen too many crump in the back of the rig in the middle of my sometimes 30 minute long transport.

What's his color, O2 sat? Is this breathing fast from no oxygen or breathing fast from anxiety over the chest pain.

ALS eta is when?

 

[wolfwyndd]

Nitroglycerin is absolutely indicated. Chest Pain, Acute Pulmonary Edema, both are treated with NTG as the first line treatment. A BP of 100/90 equals an approximate mean arterial pressure of 93, well above the recommended minimum pressure. This pt. needed NTG, preferably a NTG drip..............

Maybe for a P, but not a B. A B can only give nitro if the BP is OVER 100.

 

[FF/EMT Sam]

als arrives as the pt is being loaded in the rig. als starts CP protocall and monitor shows sinus tach. Approx 5 mins into transport, pt codes with v- tach on the monitor. 1 round of CPR and 1 shock later, pt is appologizing for falling asleep. 4 weeks later, i run into pt who told me that he had an anterior wall and an inferior wall MI at the same time. with the down time being almost non-existent, Pt has no ischemia orother deficit.

HOLY COW!!!! I wish one of my codes would work out like that!