mobey Posted December 11, 2011 Posted December 11, 2011 OK, before we get too advanced, I'd like to hear from some of our newer BLS/ILS providers..... then chbare/Squint can come school us all Called for interfacility transfer 66 y/o male longstanding history of COPD, persistant smoker, CHF, non-med compliant. Meds: Dosen't matter.... He has not filled prescriptions in years. (ventolin/spiriva/Prednisone/Metorolol/Lasix few others I can't remember but all related to CHF and COPD) HxCC: Pt presented to ER 2 days ago with shortness of breath. Worked up for pulmonary embilism with spiral CT - Negative WBC count slightly elevated at 15. No other abnormal blood values ECG normal, no chest pains. Over the last 12 hrs pt has turned quite cyanotic, he is becoming disoriented and combative at times. On arrival: you find him semifowlers in no obvious distress. He is blue as a smurf. There is a simple mask at 4lt on his obeise belly. He tracks you as you enter the room, but is disoriented. There is a 22G in his right hand and a hydrocortisone infusion just finishing. He has also had Cephalexin about an hour ago. Vitals: HR96 BP 148/90 Respitory rate 18 non-laboured, Sp02 96%, Temp 35.9C, What else would you like? BTW this is from memory, so there may be a few thing I forget. 1800th Post!!!!
chbare Posted December 11, 2011 Posted December 11, 2011 OK, before we get too advanced, I'd like to hear from some of our newer BLS/ILS providers..... then chbare/Squint can come school us all Called for interfacility transfer 66 y/o male longstanding history of COPD, persistant smoker, CHF, non-med compliant. Meds: Dosen't matter.... He has not filled prescriptions in years. (ventolin/spiriva/Prednisone/Metorolol/Lasix few others I can't remember but all related to CHF and COPD) HxCC: Pt presented to ER 2 days ago with shortness of breath. Worked up for pulmonary embilism with spiral CT - Negative WBC count slightly elevated at 15. No other abnormal blood values ECG normal, no chest pains. Over the last 12 hrs pt has turned quite cyanotic, he is becoming disoriented and combative at times. On arrival: you find him semifowlers in no obvious distress. He is blue as a smurf. There is a simple mask at 4lt on his obeise belly. He tracks you as you enter the room, but is disoriented. There is a 22G in his right hand and a hydrocortisone infusion just finishing. He has also had Cephalexin about an hour ago. Vitals: HR96 BP 148/90 Respitory rate 18 non-laboured, Sp02 96%, Temp 35.9C, What else would you like? BTW this is from memory, so there may be a few thing I forget. 1800th Post!!!! Understood, I'll keep it zipped.
tniuqs Posted December 12, 2011 Posted December 12, 2011 Squint's reading comprehension ability = D minus . 1
FireEMT2009 Posted December 12, 2011 Posted December 12, 2011 OK, before we get too advanced, I'd like to hear from some of our newer BLS/ILS providers..... then chbare/Squint can come school us all Called for interfacility transfer 66 y/o male longstanding history of COPD, persistant smoker, CHF, non-med compliant. Meds: Dosen't matter.... He has not filled prescriptions in years. (ventolin/spiriva/Prednisone/Metorolol/Lasix few others I can't remember but all related to CHF and COPD) HxCC: Pt presented to ER 2 days ago with shortness of breath. Worked up for pulmonary embilism with spiral CT - Negative WBC count slightly elevated at 15. No other abnormal blood values ECG normal, no chest pains. Over the last 12 hrs pt has turned quite cyanotic, he is becoming disoriented and combative at times. On arrival: you find him semifowlers in no obvious distress. He is blue as a smurf. There is a simple mask at 4lt on his obeise belly. He tracks you as you enter the room, but is disoriented. There is a 22G in his right hand and a hydrocortisone infusion just finishing. He has also had Cephalexin about an hour ago. Vitals: HR96 BP 148/90 Respitory rate 18 non-laboured, Sp02 96%, Temp 35.9C, What else would you like? BTW this is from memory, so there may be a few thing I forget. 1800th Post!!!! Well lets start from the beginning, Airway- Open patient? Audible sounds (stridor, gurlging, wheezing)? Breathing- Respiraton rate? Breath Sounds? capnography? Circulation- Pulse quality (strong, weak, irregular, thready, regular?) Labs showing any imbalances of electrolytes anything? Any other history of heart problems except for CHF? If they did an echo did they find anything? Has he been this cyanotic the whole time? Is this mental status normal for him? Has it deteriorated since his arrival? Any trauma or other medical history? Any food or drug allergies? Is he on oxygen now? if so how much and by which device? What is his blood sugar (strange yes, but I like to cover all bases especially with a severly cyanotic patient) Is the amount of cyanosis normal for him? Congrats on the 1800th post! 1
medicgirl05 Posted December 12, 2011 Posted December 12, 2011 Are you able to obtain any info from him? Headache? Erectile Dysfunction? Perhaps a cortisol level is in the lab report? Has he been given any other meds at the hospital? How much hydrocortisone did he receive and has he had that med before? If so, did he have any reactions? Good post! You have me thinking. I am eager to see if I am on the right track....
DartmouthDave Posted December 12, 2011 Posted December 12, 2011 Hello, I am not sure why he is blue. I will think about this. However, what I do know: 1) I do not like his temp (35.9). Hypothermia (non-environmental) is always worrysome. 2) An elevated WBC and he is on steriods. 3) He got Cephalexin. Abx for a CAP (community aquired pneumonia) 1+2+3 = septic/pneumonia as opposed COPDE? Mobey is lost in rural Alberta. So, I assume a long transport time. I wouldn't be keen on a confused blue man for a long haul without a ABG to see what his Pa0, PaCo2 and lactate are. Then think about a tube. And, a better IV than one #22. If it was a shrot transport (30-45 minutes) I would be less cautious. Cheers
DwayneEMTP Posted December 12, 2011 Posted December 12, 2011 I have no idea what's going on here, but just a thought until Mobes opens it up to the great unwashed... Are you all sure that the Smurf look is due to hypoxia? Dwayne
medicgirl05 Posted December 12, 2011 Posted December 12, 2011 I have an idea for the reason for the blueness that is unrelated to hypoxia...Don't want to completely blow it for everyone playing until we get a little more fun out of it...IF I am even on the right track! 1
Eydawn Posted December 12, 2011 Posted December 12, 2011 Wait, I'm confused. He's in a skilled facility, but he's non-med compliant on all the controllers? You get booted home if you don't play nice where I'm from. Was the cephalexin IV as well? How does the IV site look? Last oral intake? Breath and ABD sounds? Hm. Odd. Did he start the cephalexin and steroid upon d/c from the ED for PE workup? What was the indicator that sent him that way in the first place? Wendy CO EMT-B
mobey Posted December 12, 2011 Author Posted December 12, 2011 Well lets start from the beginning, Airway- Open patient? Audible sounds (stridor, gurlging, wheezing)? Patent Breathing- Respiraton rate? Breath Sounds? capnography? As above. EtC02 79 on sidestream Circulation- Pulse quality (strong, weak, irregular, thready, regular?) Weak, regular at the radial Labs showing any imbalances of electrolytes anything? Blood labs are normal except a venous PC02 of 82 Any other history of heart problems except for CHF? No If they did an echo did they find anything? No echo Has he been this cyanotic the whole time? As in OP Is this mental status normal for him? Has it deteriorated since his arrival? As in OP Any trauma or other medical history? Nope Any food or drug allergies? Nope Is he on oxygen now? if so how much and by which device? Again see OP What is his blood sugar (strange yes, but I like to cover all bases especially with a severly cyanotic patient) Not to mention altered pt's! 8.3mmol Is the amount of cyanosis normal for him? Dude you gotta read the entire original post before asking questions..... Congrats on the 1800th post! Thank you! I'll prepare a speach Are you able to obtain any info from him? Headache? Erectile Dysfunction? He becomes more orientated at times... so somewhat trustworthy periodically. No headache. Don't know ED Perhaps a cortisol level is in the lab report? Nope Has he been given any other meds at the hospital? 2.5mg Salbutamol 2 hrs ago. Had ativan SL for CT yesterday. unknown dose. How much hydrocortisone did he receive and has he had that med before? If so, did he have any reactions? 100mg iv, this is his 3rd dose in 2 days Good post! You have me thinking. I am eager to see if I am on the right track....
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