MedicAsh Posted August 12, 2011 Posted August 12, 2011 Ok guys I want to get some input. Dispatch: 90/f with chest pain and is sweaty Arrival: (Once you get into the house) You find an elderly female standing in the living room. She says she feels fine now and feels silly for calling. She agrees to be checked out. Patient is alert and oriented, skin is warm and dry, She states she had pain "here" (pointing to epigastric area) and felt like she was "going to throw up". It lasted 10 minutes and went away and now she feels fine. She woke up this morning not feeling well. Initial Vitals: 200/70 pulse 80 resps 22 O2 97% on RA Cardiac monitor shows sinus with PACs. Pain is currently at a 0/10. At its worst it was a 4/10. History: Had ovarian cancer. She is on no medications (except Tylenol PRN). She has "3" allergies but is not sure what they are. She last ate breakfast at 0600 (its now 1100). She is hard of hearing but mentally sharp as a tack. Patient does not initially want to be transported. We talk her into going in to get checked out. Patient denies pain, nausea, dizziness. Patient taken out to the ambulance. Still states pain is 0/10. As we are pulling out the aspirin and asking her if she is allergic to it she tells us that she "has problems" with it and absolutely refuses the ASA, so its not given. Patient transported. During transport she still denies pain and says she feels normal at this time. Rhythm stays sinus with PACs. Is there anything else you would have done for this patient. Don't look at this as a medic stand point. Look at it as a basic standpoint with IV and EKG certs. (Sounds strange but humor me).
Kaisu Posted August 12, 2011 Posted August 12, 2011 That BP is pretty worrisome. I would transport for evaluation. So.. good job. As far as what else you could have done.. more detail on medical history and history of present illness. Has she ever felt like this before? What did she do? Any change in life circumstances? diet? Dysuria? Constipation? Does she live alone? What does her house look like? Is she in a well ordered "healthy" environment, or does she seem overwhelmed by things? Ovarian cancer is usually a bad one. How long ago was it diagnosed? What treatment did she get? The more you find out about this patient, the better it will be for you to come up with a clinical picture, if for no other reason than to make yourself a better provider. Can you follow up with the ER and find out what if anything was going on. Think of it as a puzzle that you need to figure out. Do this for every patient. Some people have 1 year of experience 5 times. Be one that has 5 years of experience. All the best 1
ERDoc Posted August 12, 2011 Posted August 12, 2011 Other than a 12-lead, there is not much else to do prehospitally. 1
MedicAsh Posted August 12, 2011 Author Posted August 12, 2011 Our 2nd rig is a BLS rig so we dont have 12 lead capabilities on that life pack. As for history she has never had anything like this. She lives alone and the house is kept very neat (although she said it was messy. she needs to see my house LOL) There have been no changes in anything lately. She just started feeling yucky today. I can follow up tomorrow night when I go back to work. oops I just saw the cancer question. The cancer was diagnosed a long time ago and she has been in remission since.
DwayneEMTP Posted August 12, 2011 Posted August 12, 2011 (edited) Did you verify that B/P yourself, and did you trend it during transport? Any change? I'm with Ruff, within the parameters that you've allowed for this question, there is nothing else significant that you could have done. A 'just in case' IV wouldn't have been out of the question in my opinion, but I doubt I would have done so on this patient. I'm guessing that this time things are more or less what they appear to be, some minor gastric distress. Of course that ASA/transport was spot on. Good job, though I'm curious why you've chosen to keep this within the Basic SOP? Ahhh...wait, you downgraded this call and let your basic partner attend, didn't you? And now someone is trying to jam you up for allowing a BLS provider to attend to an 'ALS' patient? . If so...I'm not opposed to that decision, depending on the partner. Dwayne Edited August 12, 2011 by DwayneEMTP 1
Happiness Posted August 12, 2011 Posted August 12, 2011 I think you did fine, caught everything. One thing Iv gotten into the habit of with any chest pain is a BP on both arms. 2
DwayneEMTP Posted August 12, 2011 Posted August 12, 2011 I think you did fine, caught everything. One thing Iv gotten into the habit of with any chest pain is a BP on both arms. Why is that? I've heard this a lot, but it's never made much sense to me and I can't find any data to suggest that there should be anything more than the normal/expected few points difference between the two. What is it that you catch with this, and what makes you believe that you've caught it? Not punting your ovaries Babe...truly curious. Dwayne
DFIB Posted August 12, 2011 Posted August 12, 2011 From a BLS guy the only thing I would worry about is the BP and would have re-checked after 10 min. Was she on meds for hypertension that she had forgotten to take? What position did you transport in? I would have gone with Fowler or Semi-Fowler. I would have wanted to know if her pain was related to her breakfast. Did she eat anything different for breakfast and what did she have? Had she had any carbonated drinks? It sounds like the call was pretty flawless. Good transport desision. She definitely needs meds for BP.
BushyFromOz Posted August 12, 2011 Posted August 12, 2011 Why is that? I've heard this a lot, but it's never made much sense to me and I can't find any data to suggest that there should be anything more than the normal/expected few points difference between the two. Yeah, the people who pushed the same mantra with me were never able to explain to me how many points of difference i should be expecting in Type A or B ascending aortic aneurysm's, or just how specific it is. Actually, most told me it was for identifying AAA's
DwayneEMTP Posted August 12, 2011 Posted August 12, 2011 Yeah, the people who pushed the same mantra with me were never able to explain to me how many points of difference i should be expecting in Type A or B ascending aortic aneurysm's, or just how specific it is. Actually, most told me it was for identifying AAA's Yeah, that's what I've been told to...but I've never heard anyone justify this as a physio marker for AAA... I'm not saying that it's not good for anything, I just have no idea what in fact it might be for...people love to say, (Not meaning you Happiness) "Be sure to get a b/p on both arms!" I wanna say that! I just have no idea when to do it! Dwayne
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