What do you think was wrong with this patient

[Pavehawk]

OK. I got another one. Did she by any chance need blood products while she was in the hospital? Because... (Zebra music please)... I just learned about a condition called TRALI- Transfucion Related Acute Lung Injury, whose seminal symptoms are dyspnea, hypotension and fever...

I know it's a wild hair, but DID she get blood products? Could this be our zebra?

Wendy

CO EMT-B

I would doubt that, TRALI is generally a much quicker onset < 6 hours or so, unless she was transfused withon that period and sent home for some reason.

[Inthecity]

No, not TRALI. No blood products in hospital. BP was 170/110 and breathing 30 breaths per minute. Also not sinus rhythm but PSVT.

[ERDoc]

Large differential here. With the fever you need to think sepsis from endometritis, intraabdomenal infection, pneumonia, UTI. She's pretty hypertensive so that goes against sepsis. Others have mentioned PE, a definite possibility. Also on the differential is post-partum cardiomyopathy.

[Pavehawk]

Yep she needs a lot more work up then she is gonna get in ambulance. The hypertension asks more questions then it answers... post partum hypertension after ecalmpsia is not unknown nor is actual post partum eclampsia. Well at least she's not having a siezure!

[Just Plain Ruff]

So the consensus is that this patient is definately not stable yet we have a medic from the original poster who said she was stable.

Can the OP tell us if he knows why that medic classified her as stable???????

Enquiring minds or Just my mind wants to know?

[Inthecity]

Well the patient was actually me 1.5 years ago I had been feeling sick pretty much all day but at night it took a turn for the worst. I started having trouble breathing and within 10 minutes I was shaking so hard and gasping for air. My lips were purple. My husband called 911 and we went to the hospital and in the ambulance they said my heart rate was 225 and 104.5 temp. They were having me blow as hard as I could into this thing, and I could not blow at all. I had so little air I could not even blow air out. And they did not even put their flashing ambulance lights on! So at the hospital the nurses hook me to the telemetry monitor and the doctor comes running over and then all hell seemed to break loose. They give me 6 mg adenosine and it fails, 12 mg fails, another 12 mg fails, dialtzen (sp) several times, cardizem many times and eventually there is nothing else to give me so they use electrically cardio vert. Before that I was starting to hallucinate and hearing things that were not there. I end up the the ICU with sepsis and post partum pre eclampsia. There for 5 days on an iv of antibiotics the whole time but I got over it fairly well according to the doctors. Also liver enzymes through the roof and critically low calcium and critically low potassium. Also pancyopenia (sp??) And the ambulance drivers stayed and watched the whole time I was in the ER is that normal? Its like they underestimated how sick I was and then stayed to make sure I would make it I think.

Edited March 19, 2012 by Inthecity

[Just Plain Ruff]

Yeah, the medic was crapping his pants because he missed the boat in how sick you were. I'll bet the doc told him to stick around and maybe he might learn something.

So why did you come here with this question? The reason I ask is this. We have had in the past people come here searching for answers as to why they were treated the way they were in order to get closure, We have had on the other end of the spectrum those who have come here looking for opinions before filing a lawsuit which I might have a slight itch that it why you posted this here.

I might be wrong but my gut tells me that's why you are here. If you are here for the closure, I hope you get it. If you are here for legal ammo, well you got that here as well.

But..... in the off chance you came to learn about your condition then Good on ya, good on you for trying to learn but you should have already learned all you could from your condition in the past 1.5 years.

I won't pass judgement on this one quite yet.

Edited March 19, 2012 by Captain Kickass

[Inthecity]

Not here for any type of law suit, I lived and no permanent damage was done. Basically for closure and to see who would have acted differently. Or to see if the symptoms I presented to seem not too bad and thats why they drove there at a slow speed.

So do most medics stay around in the ER and watch the doctor work on the patient? Is that standard or up to the medic?

[Just Plain Ruff]

Cool, we've had a couple of people come in here and ask what would you do type questions and then it turns out they've been fishing for a lawsuit. glad you aren't one of those.

Good you are ok and have gotten closure so to speak.

yes some medics do but I suspect that with the doctor running around like you said he did, he might have told that crew to stick around to learn something since they at the time thought you were "stable" which it sounds as if you "Obviously" were not.

It says you are a ems student, what type?

[Inthecity]

No not a student. There was no option for just a visitor. Well take that back at age 16 I took the introductory emt course lol, but since I was so young it didnt even count. I have however been on lots of fire calls with my dad when I was young though. He was a volunteer fire man out in the country and starting at a young age I would go to all kinds of bad car crashes and medical calls. But I am definitely not wanting to file a law suit. The only thing done wrong was not getting there fast but the outcome was good regardless. Besides its been 1.5 years, if I wanted to file one I would not have waited so long.