What do you think was wrong with this patient

[Pavehawk]

Post partum hypertension is fairly common, post partum eclampsia (pre or not) is pretty rare and very nasty. Glad you had a good outcome.

To be fair to the medic(s) your disease process differetial was complex... HOWEVER they certainly didn't treat your symptoms correctly or with the urgency they deserved. Field medics often get caught up in the I don't have a clue what this is so I guess it's nothing bad cause they didn't teach me about it and we dont have a protocol for it.

What they should be doing is treating you for the adverse symptoms you were displaying... high fever dyspena, hypertensive and an SVT at >200 in a POST OP patient calls for ALS. On the bright side unless they were complete idiots (and they may be) they learned something that day that might save someone elses life.

Thanks for the intersting case!

[mobey]

Thought I would fix this up for ya

Post partum hypertension is fairly common, post partum eclampsia (pre or not) is pretty rare and very nasty. Glad you had a good outcome.

To be fair to the medic(s) your disease process differetial was complex... HOWEVER they may not have treated your symptoms correctly depending on thier protocols or with the urgency they deserved if your presentation was as you posted it here. Some Field medics occasionally get caught up in the I don't have a clue what this is so I guess it's nothing bad cause they didn't teach me about it and we dont have a protocol for it.

What they should be doing is treating you for the adverse symptoms you were displaying IF they had protocol to do so... high fever dyspena, hypertensive and an SVT at >200 in a POST OP patient calls for ALS If ALS is available in your area. On the bright side unless they were complete idiots (and they may be) they learned something that day that might save someone elses life.

Thanks for the intersting case!

Many things can effect the way we transport patients, including distance to hospital, traffic, driving experience, weather. The use of lights & sirens has not been shown to reduce transport times to the hospital in the urban setting. I routinely use them on the highway during critical transport, and shut them off once in city limits.

If this was a Basic life support ambulance in an urban setting, they may have been justified in everything they did, and we as professionals on this site have no buisness armchair quarterbacking thier call.

The fact that you were treated with pharmacologics and not electricity immediatly speaks to the fact you were being treated as a "stable" patient. I fully realize you were suffering mentally, and a HR that high cannot be sustained for too long, however, it appears you were not at deaths door.

It is very common here for EMS to stay and observe in the ER.

Edited March 19, 2012 by mobey

[Inthecity]

I never said I was at deaths door, I know I wasnt. But I bet by the next morning I may have been. Luckily my heart getting all crazy made my husband call 911, I didnt even realize how sick I was. Sepsis is really serious, but I am sure you know that. My grandpa died from sepsis a few years ago.

[mobey]

I never said I was at deaths door,.

I never said - that you said you were at deaths door.

I said I don't think you were.

I get the feeling you completely ignored the message of my post.....

[DwayneEMTP]

I don't see really how this call was mishandled, and depending on several criteria almost certainly running lights and sirens would have been inappropriate. As Mobe's said, there's no good evidence to show that it would have done you any good, but tons of evidence that it greatly increases the odds of the 'ambulance drivers' killing you and/or others.

If all of this truly came on in a 10 minute span of time, and a PE has been ruled out, then the hyperventilation was likely psychologically induced and responsible for your feeling starved for air. But without significantly more information that we've got here it's impossible to know for sure.

I've never heard of a fever that goes from normal to 104F within a 10 minute time frame, but there's much that I don't know about fevers. Though I'm confident that it came with the sepsis and that the sepsis didn't occur strictly within a 10 minute window.

The thing that they were having you blow into was likely a syringe or something of the like in an effort to vasovagal your rate down. A reasonable intervention in my opinion at that rate.

To the smart people on the board, I can't remember, but is there a relatively specific minimum rate where we can predict to within a reasonable degree of certainty that a patient will become in some way symptomatic based on retarded stroke volume alone?

A couple of questions.

What did they ultimately diagnose as the cause of your tachycardia?

If you were altered to the point of hallucinations, and have no real experience in EMS, where did you get the history of the things that happened in the ER?

I can tell you that I have stayed in the room with every patient that has confused me in any way when I could do so without delaying another call or being in the way of the ER staff. I've never had a doc tell me to "Stick around, maybe you'll learn something" but have often been invited to stay, and only once been criticized for it. It's common practice at every level of medicine to try and learn from our betters while handling real patients whenever the opportunity arises.

Interesting call...thanks for bringing it to us.

[Just Plain Ruff]

To the smart people on the board, I can't remember, but is there a relatively specific minimum rate where we can predict to within a I can tell you that I have stayed in the room with every patient that has confused me in any way when I could do so without delaying another call or being in the way of the ER staff. I've never had a doc tell me to "Stick around, maybe you'll learn something" but have often been invited to stay, and only once been criticized for it. It's common practice at every level of medicine to try and learn from our betters while handling real patients whenever the opportunity arises.

Interesting call...thanks for bringing it to us.

Had a doc tell a medic one day who royally screwed the pooch on a patient, took the patient down the primrose path to cemetary ville, the er docs brought her back to the land of the living tell a medic point blank, stick around, you need to realize what you have done and what you have to do to reverse what you did so next time you won't do what you did again.

We all learned a lot that day.

[Eydawn]

Wow! Okie doke. This changes things a tad.

First off, thanks for bringing us this scenario. We don't discuss OB related stuff as much on the City, and it's good to shake our brains a touch.

Could I try to explain something to you? There's a huge difference between medical professionals/students presenting each other with case scenarios (AKA: I saw this, I did this, this is what I thought, and this is what it turned out to be) and using scenarios in which you were actually the patient. When you're the patient, all of a sudden, there's this huge bias in what you're presenting whether you want there to be or not.

For example... I have pretty wicked asthma. When I worked at the Boy Scout camp in '06, I was not real compliant on my meds, and there were a LOT of allergens/stressors. I had a few wicked attacks, treated by my coworkers (I was a medic on the ranch). My memories of those nights are not clinically sound. I felt like I was dying. Was I? No... because nobody called the local crew (with their entire ONE ALS intermediate guy) to intubate and transport me. Was I pretty nunngered, to use Kiwi's phrase, for a while? Sure. But not dying. There's a reason I don't use those calls directly when I'm discussing respiratory issues on the City, nor do I present them as case studies of people whose care I was involved in. Do I know a lot about what went down? Sure. But I can't remain objective on it, no matter how hard I try.

We're really glad you're just looking for a "well, what would others have done with this" sort of deal and not looking to sue... we've had people come in and misrepresent themselves before as students or providers, only to be lawyers or aggrieved patients looking to get evidence to build a case. The biggest thing we're missing, in what you presented, is actually having been there ourselves providing care. I can tell people that I thought I was going to buy a tube, but I can't tell them what my clinical presentation was, my skin color, my work of breathing, my sats, my vitals... what kind of status I was really in. Was I stable? Was I unstable? Only my three guys that were taking care of me really know.

Point being- it's different to try to retrospectively analyze a call that you were providing care on, or were presented from another clinician, than it is to analyze a call provided by the patient (especially if that patient is not in fact a medical provider of some level).

So, short story- thanks for playing with us! We can't tell you how stable/unstable you were, but the call was interesting for us to look at!

Wendy

CO EMT-B

[Kiwiology]

I agree with Wendy but thank you anyway for an interesting case, we don't do paeds or gynae much

[Inthecity]

I got all the info from my medical records. I requested them after the incident just to better figure on what was going on. And I NEVER said I went from no fever to 104.5 in 10 minutes. I never even knew the entire time I had a fever.. I could have had it for hours. I just know I felt bad all day and it then the breathing problems and shaking started which made my husband call 911 and from there it was getting worse quickly.

The ambulance driver was the one who told me I had a fever... I knew I felt horrible obviously but didnt know about the fever. And it was Supraventicular Tachycardia, that was the heart rhythm. It was the first and last time I ever had that.

[HellsBells]

Initally, I was thinking perhaps malignant hyperthermia may have been the case, although it generally occurs within minutes or hours of sedation.