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nyc.ems

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39 y/o f,no medical hx,c/o chest pn radiating to right flank.pt sts pn is sharp then pressure,with pn radiating to the back at times.v/s are as follows;142/92 p=100 r=20.pt denies vomiting,but feels nausea at times.dizziness on and off,slight headache.onset of 20 min.some tingly feeling to both upper extremities......reply what you think.......answer when i return.....:ph34r:
 
Is this the same one we talked about or a different pt?
 
Either gallbladder or spleen?
 
Im thinking gallbladder - but usally gallbaldder pain starts under the shoulder blade and radiates to the flanks.

Can you give us more info?

-CP
 
there are no other s/s for this pt.pt denies any other pn and has no med hx
 
smoker.....?
 
nyc.ems said:
39 y/o f,no medical hx,c/o chest pn radiating to right flank.pt sts pn is sharp then pressure,with pn radiating to the back at times.v/s are as follows;142/92 p=100 r=20.pt denies vomiting,but feels nausea at times.dizziness on and off,slight headache.onset of 20 min.some tingly feeling to both upper extremities......reply what you think.......answer when i return.....:ph34r:
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Lez' break it down..

BP Could be explained b/c of pain.. as could pulse. She really isn't breathing that fast.

But since the respiratory rate you take only applies for that minute that you took it, she could be slowly hyperventilating. That may explain tingling in extremities.

Of course if it really isn't chest pain, and it's extreme upper abdominal pain, it could be intraabdominal bleeding. To compensate for blood loss to major organs, the body regulates flow to other areas. This causes pain in the joints of the arms and legs, cause they aren't getting enough oxygen rich cells and blood flow.

I'm not guessing the diagnosis.. just because.. besides.. I'm not a doctor.
 
Could be lots of things...I need a 12 lead, pulse ox, orthostatic b/p, lung sounds...possible dx: hemothorax, pneumothorax, cephalic hyperventialtion syndrome, gallbladder, pancreas, uterine issue, kidney, diaphramatic, AAA leaking, c-spine fx could cause this also...turning your neck the wrong way will fx it-had a pt would did just that and presented similar to this...
Overall the bp is not that hi, nor is the pulse rate...the r/r is the high end of normal, but it could be kussmal or some other abnormal respiratory pattern...interested to see what this really is
 
reply what you think
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report vitals, Hx, med's ,alergies, age, sex, cc, interventions, start iv draw bloods, trans in p.o.c. and note changes

we don't diagnois.

~S~
 
in vermont you might not diagnose,but in new york we do...B)...r/o was acid reflex.after a full upper gi workup...found out this pt. had multiple superficial ulcers,esophigitis,hyatal hernia.also an acute anxiety attack.any experiencing chest pn would panic...ekg showed up normal as well as cardiac enzymes....who would have known:rolleyes:
 
nyc.ems said:
in vermont you might not diagnose,but in new york we do...B)...
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Maybe it's just because I've been "off the streets" for a few years now, but how can you say you diagnose, or better yet why would you say you would diagnose? It's not like you can request tests be ran or provide long term medications for the pt or create a discharge plan.

:unsure:
 
He is SC we dont diagnose per say, however we are expected to know ALL the possible diagonses and the anatomy involved with it, i.e. ABD pain- you must be able to treat ALL ABD issues from a belly ache to ectopic pregnancy to AAA...we are expected to be knowledgable of the disease processes involved and we are expected to be able ot rule out certain things as the reason they are sick...but thats only here in SC
 
FFEMT1764 said:
He is SC we dont diagnose per say, however we are expected to know ALL the possible diagonses and the anatomy involved with it, i.e. ABD pain- you must be able to treat ALL ABD issues from a belly ache to ectopic pregnancy to AAA...we are expected to be knowledgable of the disease processes involved and we are expected to be able ot rule out certain things as the reason they are sick...but thats only here in SC
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....Us too.
 
Glad to see that SC isnt the only place :)
 
Don't kid yourself....What do you think you do on the Assessment portion of your SOAP charting?

It may not be a definitive diagnosis, but it is still a diagnosis because you base your treatment plan on what you think is probably wrong.
 
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