Congestive Charlie

[Kiwiology]

You're sent two suburbs over to pick up Charlie fron a walk in medical centre and take him to the hospital.

- 84 year old male complaining of severe SOB

- Immeadiate hx of feeling sick for 5 days, no significant prior history

- Looks sick; pale, sweaty, nauseous, feels fluey, markedly increased work of breathing

- HR 63, RR 24 laboured, mid & basal crackles, speaks 4-5 words per sentance, temp 38.5°, ECG new onset 1° AVB with bigeminy PVCs

- No meds, NKA

The doctor is trying to find some chest films he took and it'll take a minute or two.

This is a two part scenario:

a) BP is 96/86, how do you treat?

a) If BP was 136/96, how would that alter your treatment?

[Arizonaffcep]

You're sent two suburbs over to pick up Charlie fron a walk in medical centre and take him to the hospital.

a) BP is 96/86, how do you treat?

a) If BP was 136/96, how would that alter your treatment?

From the founds of it,I would think infection moving along to sepsis. Pneumonia? For me, continue any meds that need to be continued (ie abx), other than that, supportive measures. Give him as much O2 as they can tolerate, possibly fluid challenge for decreased B/P. Reason for possible fluid challenge with wet lungs-infection causing wet lungs vs CHF/ARDS, etc. In my eyes, this seems to be a fairly obvious infection-hence the temp.

[P_Instructor]

You're sent two suburbs over to pick up Charlie fron a walk in medical centre and take him to the hospital.

- 84 year old male complaining of severe SOB

- Immeadiate hx of feeling sick for 5 days, no significant prior history

- Looks sick; pale, sweaty, nauseous, feels fluey, markedly increased work of breathing

- HR 63, RR 24 laboured, mid & basal crackles, speaks 4-5 words per sentance, temp 38.5°, ECG new onset 1° AVB with bigeminy PVCs

- No meds, NKA

The doctor is trying to find some chest films he took and it'll take a minute or two.

This is a two part scenario:

a) BP is 96/86, how do you treat?

a) If BP was 136/96, how would that alter your treatment?

Are the bigeminal PVC's perfusing? Are you assessing the monitor (fail) for HR of 63 or the patient?

[Richard B the EMT]

Please clarify something for me. Charlie's temperature is 38 point 5 degrees? Either he is hypothermic, as the temperature is below 80 degrees, normal being 98 point 6, or someone forgot to indicate Fahrenheit versus Celsius.

Sorry, I'm used to working with the Fahrenheit scale.

[P_Instructor]

Please clarify something for me. Charlie's temperature is 38 point 5 degrees? Either he is hypothermic, as the temperature is below 80 degrees, normal being 98 point 6, or someone forgot to indicate Fahrenheit versus Celsius.

Sorry, I'm used to working with the Fahrenheit scale.

Looks like the conversion is 101.3 F.

[Kiwiology]

Yes the PVCs are perfusing; you can treat whichever you like

[Arizonaffcep]

From the founds of it,I would think infection moving along to sepsis. Pneumonia? For me, continue any meds that need to be continued (ie abx), other than that, supportive measures. Give him as much O2 as they can tolerate, possibly fluid challenge for decreased B/P. Reason for possible fluid challenge with wet lungs-infection causing wet lungs vs CHF/ARDS, etc. In my eyes, this seems to be a fairly obvious infection-hence the temp.

Sorry for the development of a typing lisp...not sure what happened. In reading over this again, would probably go with a breathing treatment as well.

[Kiwiology]

OK you give 5mg of salbutamol, patient says its now harder to breathe and his resp rate has gone thru the roof

[Arizonaffcep]

OK you give 5mg of salbutamol, patient says its now harder to breathe and his resp rate has gone thru the roof

What's his 12 lead look like?

[Kiwiology]

What's his 12 lead look like?

1° AVB (new onset) and bigeminy PVCs with no specific ST segment changes