Kiwiology Posted May 1, 2009 Posted May 1, 2009 You're dispatched to a neighbourhood medical center for an old lady who says somebody stole her breath. Upon arrival you find a police officer standing in the triage bay; he tells you he has not been called to take a theft report and points you to one of the nurses. One of the nurses leads you to one of the rooms where you find a 75 yof cc sob. Over an hour ago the CNA put her on salbutamol and it's been running ever since because they are busy the CNA was needed elsewhere. S - SOB, diaphoretic, skin cool/clammy and feels light headed A - nil M - atrovent, nadolol and januvia P - mild asthma, HTN, NIDDM L - breakfast q 6hr ago E - nothing remarkable Vitals BP 140/90 RR 24 with insp wheeze spO2 95% CR < 2 s. PR 100 GCS 15
Katiebug Posted May 1, 2009 Posted May 1, 2009 I didn't know there was a machine that would deliver albuterol constantly. If she's been recieving albuterol for an hour straight, the three things I would be concerned about are disrhythmias, bronchiospasm and hypokalemia. Certainly d/c the albuterol and admin high flow O2. EKG please.
Kiwiology Posted May 1, 2009 Author Posted May 1, 2009 I dno if there's a dealie that does it contionously; I made that up so the scenario based off things I read in two journals at 1am would work, shudddddupa your moutha!
Gypsy Posted May 1, 2009 Posted May 1, 2009 May I have an acucheck done please? You said there is wheezing. Is it audible or did we listen to breath sounds already with a stethesope?
Katiebug Posted May 1, 2009 Posted May 1, 2009 (edited) Well, hypokalemia shows as a flattened T wave. This one is inverted so I'm guessing coronary ischemia. I'm not brilliant with EKGs like some of the folks here, so I'm giving high flow O2, ASA, maybe a nitro, high flow deisel and monitoring for changes. Also what Gypsy said-let's get a BGL. Edited May 1, 2009 by Katiebug
VentMedic Posted May 1, 2009 Posted May 1, 2009 I didn't know there was a machine that would deliver albuterol constantly. If she's been recieving albuterol for an hour straight, the three things I would be concerned about are disrhythmias, bronchiospasm and hypokalemia. Certainly d/c the albuterol and admin high flow O2. EKG please. Albuterol can be given continuously for several hours at dosages of 5 - 30 mg/hr and it is usually given by O2 with an aerosol mask considered to be "high flow". To cause a shift in K+ effectively for a short time, one would have to give a high dose of concentrated albuterol (0.5%) at 15 - 25 mg with a rapid delivery time. Unfortunately, some (EMS included) believe they can do a continuous Albuterol treatment by just putting several unit doses into a nebulizer that might not be designed for that volume. At the rate of nebulization, the baffles may deliver an inconsistent output of particles size and dose. Thus, as we fondly call it when we see this arrive in the ED, "Sputtering in the Wind".
Katiebug Posted May 1, 2009 Posted May 1, 2009 Good to know Vent. What's your take on the pt? You're probably better at EKGs than I am.
Jeepluv77 Posted May 3, 2009 Posted May 3, 2009 Are those pacer spikes or huge q waves? Leads I, II, and the rhythm strip at the bottom. Is this the "q wave infarction" I'm not quite clear on yet? And what's the significance of V4, V5, and V6 showing nothing? Are we just missing an electrode? If so, could that be part of the reason for the st deviation in leads I, II, aVr, V2, and V3? Turns out we don't really get into 12 lead much till next semester, so bear with me here.
Katiebug Posted May 3, 2009 Posted May 3, 2009 (edited) Are those pacer spikes or huge q waves? That got me too. I finally decided it was huge q waves. The pacemaker spikes I've seen to date have always gone the same direction as the qrs. Am I off on that? Edited May 3, 2009 by Katiebug
Kiwiology Posted May 3, 2009 Author Posted May 3, 2009 BGL is normal at 5 mmol (90 ml/dl) Are you sure you want to give this pt. an NSAID given she has asthma? You give the pt. 3 x .4mg nitro's but she said it makes no difference
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