What do you think was wrong with this patient

[DwayneEMTP]

Dwayne I am not getting defensive. So is it just a coincidence that I had a "panic attack" at the time when I fell ill with sepsis and PP pre eclampsia? And I never had a panic attack before in my life, never had one after. Thats the only time in my life I could not breathe... when I had the 225 heart rate and 104.5 temp.

Had you ever had sepsis before? Or PP pre eclampsia? Or PSVT? Have you had any of them since? Yet you had them in unison, right? Why is it that a possible anxiety attack is the only thing that you find just to outlandish for belief?

It matters not at all to me if it was dyspnea from retarded stroke volume secondary to PSVT, an anxiety attack, or the after effects of being rudly probed by aliens. The symptoms as you've described them here leave plenty of room for interperetation, and that's all that I've been doing.

You seem very committed to DOB from PSVT. Ok. Whatever happened you were certainly a very sick lady. You want it your way, then good on you. But until one of our docs or super cardiac folks chimes in to comment, then other explanations exist.

This is a learning forum for medical professionals. Taking things apart and looking at the pieces is what we most often do.

No one is trying to take away any of your cooler sounding pathologies.

Dwayne

[ERDoc]

Both sepsis and SVT can cause dyspnea. Did we ever learn what the source of the infection was? As for the care provided by the ambulance crew, I don't see anything they could have done differently. They do not have the ability to give antibiotics or take blood cultures (in most places). They only thing they can do in this case is give fluids, treat the SVT and transport. It sounds like everything that needed to happen happened. Lights and sirens are overrated and make for good TV.

[Inthecity]

The source of the infection was endomitritis the infection of the uterus. ER doc: so the rapid breathing was due to SVT AND sepsis right... not panic like another medic said. The doctors at the ER told me thats why I was having a hard time breathing. They never once mentioned me panicking and that is also not in my records.

Edited March 20, 2012 by Inthecity

[Just Plain Ruff]

I think without having your records in front of any of us we aren't going to be able to make any sound judgements.

I for one don't think you were having a panic attack or anything of the sort. But I wasnt' there nor were any of us so I think trying to armchair quarterback a cryptic call from 2010/11 is pretty tough to do.

We also don't know what that tube or whatchamacallit/hoozit they had you breathing into was we will never know unless it's the center of a tootsie roll pop and then the world only needs to watch the owl bite into the tootsie roll pop and we all will know.

But I digress.

You seemed to fare well from your illness and coming here seems to have provided some sort of closure although maybe not the closure you wished for.

[ERDoc]

Your trouble breathing MAY have been caused by the SVT/sepsis, but the whole situation can also cause anxiety which can cause dyspnea. Like others have said, we weren't there so there is no way for us to say. It could possibly be a combination of all of the above, some of the above or none of the above. As for the medic sticking around, it happens all of the time. They like to know what was going on when the dx was not so clear.

[DwayneEMTP]

Hey Doc,

What would be the physiology behind the dyspnea secondary to sepsis without vasodilated pressure issues? Or perhaps there's not an answer there that's easily explainable at a level I'm likely to understand?

OK ITC, I take back the anxiety attack comment. It's obvious that you're unwilling to consider any possible complications that you've not seen on House. No sense muddying up the thread with that conversation.

I will tell you this though. If you're an EMS student, you're really, really far behind the eightball when you reject a possible diagnosis because you don't like how it sounds. Particularly when it's obvious that you have no idea what I'm even talking about as it relates to you.

In EMS as in all other medicine you follow the signs and symptoms where they lead you, not where you wish that they would take you. And despite what you may believe, reading your discharge papers at your level of education can make you more confused than you might imagine. Google can be your friend if you also have the education or experience for the necessary context.

A good example of this is your claim that I stated that your dyspnea was secondary to 'panic' when what I theorized was a panic/anxiety attack. (Most often I would use the term 'anxiety attack' when relating to other professionals, I added panic as it's a more common laymen term.) The two conditions are, except rarely, completely unrelated.

But, as you find it to be such an incredibly vital point, I will from here on out consider my theory thoroughly disproved.

[mobey]

Hey Doc,

What would be the physiology behind the dyspnea secondary to sepsis without vasodilated pressure issues? Or perhaps there's not an answer there that's easily explainable at a level I'm likely to understand?

I assume by Doc, you meant me?

j/k... I actually just want to jump in here so I can show off a little then get knocked down a peg and learn from our resident doc's

Dyspnea in Sepsis:

During sepsis the patient will present with incresed lactate levels. Lactate is a byproduct of hypoxic tissues utilizing anaroebic metabolism as seen in sepsis. Lactate (Lactic acid) is transformed into C02 and H+ and creates a acidotic state. Because our resiratory drive is based on Ph values in the CSF (chemoreceptors) this stimulates tachypnea in a effort to blow off the extra c02.

Done without refreshing, so excuse the errors.

[ERDoc]

A fever by itself can also cause tachypnea. I have to admit that I don't know the mechanism, but I would guess it has something to do with thromboxane. Maybe our resident Kiwi house consultant surgeontologist can help us.

[Inthecity]

Dwayne I am not a EMT student, I just thought you had to be in that field to join. I am just an 8th grade math teacher. Also I am not into House or Greys Anatomy. I have never even seen those shows and its not even my interest. I was just curious about what professionals like you thought and thinking about how that night was the worst of my life. I jhave been thinking about being in the ER getting adenosine 3 times among other drugs, being shocked and having no idea what was going on. I had a 3 day old and a 4 year old at the time and I was scared I was going to die. Then spending 5 days in the ICU without my new baby or my 4 year old. After the ICU another 4 days in the hospital. It was awful and I hope it never happens to you or anyone else who seems to be mocking me a bit.

Edited March 21, 2012 by Inthecity

[mobey]

No one is mocking you.

We are getting frusterated, and for good reason.

We get alot of patients just like you who do not understand why you were treated the way were and have questions. The problem is, your questions revolve around a seperate agenda, and it is one we are all too familiar with.

Your posts give the impression you were looking to point fingers at these medics, Perhaps that is not the message you were trying to send, but that is the one recieved. When us rounded Paramedics validated the way you were treated (ie; no lights & sirens, possible hyperventilation) you rejected the idea. That only solidifies in our minds, that you are not looking for widespread reasoning or explination, you are looking for validation of your distaste for the way you were treated by EMS.

Well sorry to spoil your pity party, but as EMS professionals, it is not our perogative to judge eachother behind our backs (or at least it should not be, and some still have some professional development to work on).

I realize you are reading medical records, but you should really put them into perspective, do you really expect a Doctor to write "Patient appears anxious" in his notes?..... not likely. But hey if ALL the details were in those charts you would not be asking us questions right?

Then stop rejecting our answers.

You are an educator, you can do better than this.