zippyRN Posted August 21, 2008 Posted August 21, 2008 this is one for all skill levels to play you are on duty in a medium sized town, it is a pleasent bank holiday Monday and there is a Carnival / parade in town you are called to an 'unwell male' on arrival at scene you find a 30 something year old male who is sat in his own self propelled wheelchair R alert A clear self maintained, B present normal C present , face appears a little flushed, mildly bradycardic, D GCS 15 /15 upper limbs normal, lower limbs very weak
zzyzx Posted August 22, 2008 Posted August 22, 2008 "Hello, Sir. My name is Nigel. I'm an ambulance attendant. Yawright?"
Christopher.Collins Posted August 22, 2008 Posted August 22, 2008 Chief Complaint? Vitals (including skin temp/appearance)? SAMPLE/OPQRST? Reason in wheel chair? Able to ambulate at all? Check PMS of lower extrematies; compare to hx/reason in wheel chair and pt's (stated by him or family) normal PMS Start on high 15 lpm via NRBR
zippyRN Posted August 22, 2008 Author Posted August 22, 2008 Chief Complaint? unwell, pounding frontal headache Vitals (including skin temp/appearance)? p 50 , bp 155/90 rr 16 , spo2 98%on room air t = 36.7, blood sugar 6.7 mmol face, upper chest and arms quite flushed , lower limbs normal to pale SAMPLE/OPQRST? Allergies - none known Meds baclofen 10mg bd , movicol one sachet on, paracetamol 1 g PRN, lansoprazole 15 mg om , something else the patient can't remember as a PRN PMH t 4 paraplegic folllwing motorcylce RTC - some lower limb fractures at the time - now all fixed reasonably , superpubic cather insertd during rehab L - had a decent breakfast this morning, cereal, fruit juce, bacon cob, mug of tea, has had a bottle o water and a can of pop this morning while out E - no particular events while out today - no new non trivial trauma P - no particualr provoking factors for the pain - itl;s constant Q - pounding / banging R frontal headache S 5/10 T head ache noticable about 30 minutes ago , patient;s partner noticed he looked flushed aobut 5 -10 minutes before call for help Reason in wheel chair? Able to ambulate at all? T4 paraplegic following motorcycle RTC 4 years ago , pretty much complete SCI can transfer can't stand without support due to near complete lesion and spasm Check PMS of lower extrematies; compare to hx/reason in wheel chair and pt's (stated by him or family) normal PMS no neurological changes from normal for patient
Timmy Posted August 22, 2008 Posted August 22, 2008 How long has he been on movicol and lansoprazole for? What’s wrong with his stomach? How long has the catheter been in for? Has he experienced any discharge/redness/swelling/tenderness around the insertion site? Is he normally hypertensive? What’s his temp? What’s the ECG looking like?
zippyRN Posted August 22, 2008 Author Posted August 22, 2008 How long has he been on movicol and lansoprazole for? What’s wrong with his stomach? nearly 4 years How long has the catheter been in for? has hada SPC for 3 and a half years, current catheter is a 12 week one and it;s been in 9 weeks Has he experienced any discharge/redness/swelling/tenderness around the insertion site? insertion site, clean ,dry and not inflammed Is he normally hypertensive? if any thing his BP is normally on the low side What’s his temp? not pyrexial What’s the ECG looking like? sinus brady
Timmy Posted August 22, 2008 Posted August 22, 2008 Hmmm... Any neuro problems? Pupil reaction/size? Motor-sensory issues? I'd say the headache may be caused from the hypertension. Is the brady normal?
zippyRN Posted August 22, 2008 Author Posted August 22, 2008 Hmmm... Any neuro problems? no new neuro Pupil reaction/size? normal size reactive Motor-sensory issues? normal for him , few more spasms than usual I'd say the headache may be caused from the hypertension. quite possibly
Timmy Posted August 22, 2008 Posted August 22, 2008 Also, what's his skin turgor? Urine Output? Appearance of urine in cath bag?
zippyRN Posted August 22, 2008 Author Posted August 22, 2008 Also, what's his skin turgor? Urine Output? Appearance of urine in cath bag? he's not dehydrated he;'s had a glass of fruit juice and a mug of tea at breakfast and a 500 ml bottle of water and a '12 oz' can of pop since ... however his urine bag is empty ... ( not leaking , emptied before breakfast - when it was nearly full )
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