BushyFromOz

Unknown if last bowel movement reduced pain, uknown escessive thirst but she has had a lot to drink today You start transporting to the recieving facility which is 50 odd minutes away. Backup is probably 25 minutes away if you want them in a hurry. Once you load her onto your stretcher, you place her R lateral again with her legs drawn up, facial grimace stops. You do another assessment and nil has changed. You look for a vein to stick a line in and note someone has already had three attempts in the only 3 veins you can find, her skin and veins are terribly fragile and has a shiny lustre, you wonder if she is on prednisone. You and your partner each have an unsuccessful attempt and decide that the patient is reasonably comfortable and you should start heading towards the recieving hospital. You let the back up crew know that they may be needed for some IM fentynal. (bear in mind, the patient has had no pain relief for several hours and is generally comfortable) you and your partner think better be closer to backup then keep stuffing around so far from it, 02 goes on and you head out of town. half way to the recieving facility, your pt has a lucid moment, and has a frank conversation with you. She says that her tummy hurts (cant rate it, cant localise it) and that she feels like she needs to wee before she goes back to talking dribble. Another set of obs reveals no change from the intial assessment. What would you guys have done in regards to treatment???

Transfer was for treatment/assessment for a bowel obstruction.

No blood and no imaging doc, imaging would have been really handy...

i was in another forum and sorta followed dustdevil in here

Stool was normal, dark brown and not too soft, as were all stools for the week Nil Hx of liver problems Paracetamol for 2 weeks at 4 hourly intervals Paracetamol was started because of abdo pain (we didn't know this at the time, found it in the med charts later) Nil gastric reflux Nil passing gas Diet is normal nursing home/hospital fare Pt has had plenty to drink - approx 2 litres today with nil output Unknown cause of UTI

Will wait for some more questions first, especially suggestions on treatment. Was hoping there would be more replies :? Thanks to you guys who are playing along 8)

Whoops, sorry, and i will stop using aussie medication lingo Okay, sending facility is very rural, limited medical staff (more like a nursing home with an "urgent care center") in fact, ther is not even a GP in attendence, the nursing staff are taking Dr's orders over the phone, and the only "work up" she had was a GP consultation about 2 hours ago with no available obs or vital signs. Dementia is very advanced, the patient tells you her washing machine jumped about six feet and out of the door when you introduce yourself. The family member has no idea of mothers history last bowel movement this morning with normal appearance Its unknown if pt has voided any urine at all today, though she has been "drinking plenty of water" Last time she ate was lunch time (beef soup) Uknown time of onset of "pain", nursing staff noticed her guarding this afternoon Unsure of provocation, though movement seems to illicit a facial grimace type response, though not consistently every time she is moved. Unable to localise pain and unable to rate Nil follow up since UTI that you are aware of, pt is on a cephaliosporin anti-biotic for it Vomit about half hour before your arrival, nurse says there is no fecal matter in it Unknown if malena or hematuria No known liver problems Abdo soft, nil facial grimaces on palpation. Nurse thinks that her tummy may be a little bit bigger but she is not sure A= Nil allergies M= Laxative, ACE inhibitor, Beta Blocker, Aspirin, Paracetamol P= Jaundice for 1 week, fecal incontinance, CVA's in 05 and 07 with Left sided deficit, Dementia, L4 crush/fracture in january this year, type 2 non insulin dependent diabetes, renal calculi, hypertension and a urinary tract infection last month L = Beef soup E = unknown, was just found with gurding this afternooon HR = 110 B/P = 150/90, radial pulse feel weak though RR = 18, clear, low tidal volume Temp = 37.7 tympanic BSL = 14.9 ECG = Only 3 lead available its non diagnostic Sinus Tach GCS = 13 (E4, V4, M5) Pt appears to be reasonably comfortable

Ok, i dont normally post case studies ( in fact, im not sure i ever have before) so bare with me............. Despatched to a routine transfer for a ? bowel obstruction. O/A you find a 90ish y/o female laying R lateral with abdominal guarding. You note she is a bit jandiced and obviously uncomfortable. Pt has a Hx of fecal incontinance, CVA's in 05 and 07 with Left sided deficit, Dementia, L4 crush/fracture in january this year, type 2 non insulin dependent diabetes, renal calculi, hypertension and a urinary tract infection last month. She has had 50mg of pethidine IMI and 20 mg Maxalon IMI at five and a half hours ago and another one just as you walked in the door. You can smell vomit in the air, and notice the clean bedpan on the floor next to her bed. A relative says she has been complaining of back pain for 2 days. What would you like to know and what would you like to do?

Thats funny right there!

:shock: :shock: :shock: Ok, so its somewhere between 60-100 Awesome, its all falling into place :roll:

sorry mate, i misread one of your other posts, forget the qestion, i have saeen the light (much like this patient may)

Tombstones...... I dont have 12 leads to work with. In fact, the 3 leads we have are non-diagnostic so i would be in the funky position of weather to give nitrates or not with this pt with LD 2 and 3 like that. :? chbare, would'nt there be RAD or LAD for a BBB? not questioning you, 12lds are outside of my abilities so i only know what i have taught myself O2, ASA and morph. And a big IV, and IC crew would be good as well

I think people like this priest need to give kids more credit. Its like drugs and alcohol. Fidgureheads get on the TV and rabbit on about how role models influence kids into alcohol and drugs like they are some kind of brainless group of people who have no concept of right or wrong. kids know its wrong, and unhealthy and dangerous, but they do it anyway. Some of the brainiest down to earth people i knew when i was in high school did some really really stupid things, not because they didn't know the consequences, but because they could do it anyway.

I would think one would be careful not to get suckered into treating a it as a PEA arrest from increased intrathoracic pressure. If its an unconscious astham with a cardiac output we jab em' with .3 of adrenaline IMI. If they lose output and provided they havn't tensioned or just have some mega gas trapping going on, im sure the 1mg of IVI adrenaline will sort out there constriction.

"when your love is gone" - Jimmy Barnes

LMFAO! Absolutely priceless ruff, where did you find that gem?

Yeah, but for some reason i thought that was a late sign.

Duh!!!! Yeah, aneurysm far more likely. Dunno how i cam up with that blinding tamponade assessment :shock:

So, steve. If you had to have a degree or a diploma in paramedicine instead of your night school to get your paramedic qualification would you have put in the time and effort?

Point taken, i'd have to say with the amount of misrepresentation that goes on around here on ones own credentials, my BS radar is probably set far to high these days. Oh shit, im getting cynical, im far to young for that :shock:

im not sure if this is a joke or a stab at something??

Dude, how ould you know what dispatch would say?? Set your age to 14 where it should be, and im curious as to how you are going to judge people answer as an EMT P if your not even a basic? Other than that, cinnamon!!! WTF!! :laughing6:

:roll: :roll: :roll: :roll: :roll: :roll: :roll: :roll: :roll: :roll: :roll:

cardiac tamponade or pulmonary contusion? Long shot, might have a beer