Sick Person Call (Who is actually sick!)

[DartmouthDave]

Hello,

You are dispatched to a suburban home for a 'sick person'.

On arrivial you are greeted by the patient's son. He says his mother is acting funny and hasn't been well for the last week or so. He ushers you into the kitchen.

The patient is sitting at the table looking pale, weak and is having trouble sitting up in the chair. He breathing is laboured. Two of her grandchildren are supporting her. Thier is panic in the air.

Cheers

[medicgirl05]

For starters....

Is she alert and oriented?

What are her vitals?(pulse ox, pulse, BP, respirations, BS level?)

Lung sounds?

Medical history?

Complaining of pain anywhere?

[scratrat]

Need a WHOLE lot more information than that or am I supposed to drag it out of you like you're the patient?

[rock_shoes]

Need a WHOLE lot more information than that or am I supposed to drag it out of you like you're the patient?

That's usually the idea with these things. Take it as on opportunity to improve your patient interview skills.

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[DFIB]

What is the patients age and approximate weight?

Has she had any sudden weight changes?

What does the house look like? Clean? Disorderly?

What is the patient's ethnicity?

Does the son look like a crack head?

Does the patient look like a crack head?

Does she track me with her eyes when I come in?

Vitals including SPO2?

Eyes?

Smooth pursuit?

Convergence?

Ears?

Does she have jugular vein distention?

Is her trachea inline?

Is her speech interrupted?

Lung sounds?

Does she have associated chest pain?

Does she produce sputum? Color? Amount?

Is she taking Medication?

Does her condition change with exertion or exercise?

Has she had a diagnosis by a DR?

IF she presents associated chest pain When was the Onset?,Is there anything that Provocation or Palliation?, What is the Quality of pain?, Is there Pain Radiation?, How severe is her pain? Has this happened before?

Does she have an altered mental status?

Pupils?

Nausea/Vomiting?

Skin turgor? Mucouse membranes?

Is her abdomen tender or distended?

Is weakness weakness bilateral?

What is her Cincinnati Trauma Scale score?

EDIT: Is she a smoker?

Edited September 29, 2012 by DFIB

[DartmouthDave]

Hello,

The patient is 79 years-old and a full code.

Some information from the son;

His mother has been unwell for a week. She had a lung infection and has been taking pills for it. He is unsure of his mother's medical history because she is a private person. But, he sure she has high blood pressure and swelling of the ankes. She quit smoking 10 years ago and has troubles with her sugars. That is all he knows.

He picked up his mother today at her home for a family dinner. She was weak but insisted on coming to see the grandkids. He wanted to take her to the clinic to see her Family Dr.

You transfer her to the strectcher and do your assessment. Here is what you discover;

-->GCS 13/15 (E3 V4 M6) confused, mumbling words, able to follow simple commands

-->Pupils: 4mm and reactive

-->Arms: weak (no drift)

-->Legs: weak

-->Lungs: very course

-->Skin: very hot to the touch, diaphoretic, swollen ankles (+1 edema)

--> You are unable to get any useful history or information from the patient due to her mental status

VS:

HR 150's A.Fib with narrow QRS and occassional PVC

BP 80/30

Temp: 39.7

O2: 87% on room air (creeps up to 90-91% on o2)

BGL: 14 mmol/L (252 mg/dl)

Edited September 29, 2012 by DartmouthDave

[scratrat]

1. Dehydration

2. DKA

3. Sepsis/pneumonia

[Bieber]

Febrile with hypotension and a known infection meets the criteria for sepsis. Pedal edema could be due to decreased mobility (due to the illness) and/or worsening right sided heart failure due to increased pulmonary resistance secondary to swelling (not confirmed cardiac history, but a previous history of diabetes and smoking puts her at increased risk for it). Sugar's high, but given her history of uncontrolled diabetes it may be due to that or just due to poor glucose homeostasis secondary to the infection itself--I'm betting on the latter. Given the severity of her illness, I don't think we're seeing BGL levels high enough to be the causative factor here.

Let's decide to either start working her here or get her out to the truck so we can get a line and start pumping some fluids into her (given the family's emotional state, the truck might be better).

You said lung sounds were coarse? Are we talking rhonchi or do we have any wheezes in there? If signs of bronchoconstriction, let's try a duoneb; otherwise let's titrate our oxygen up and see if we can improve her oxygen saturation to ~95%. Wherever we go, let's try a liter of fluid for now and reassess.

Also, can we find out what antibiotic she was on? Might give us an idea whether or not the doctor who diagnosed her had identified a causative agent or if she was just prescribed a broad-spectrum antibiotic for pneumonia. What facility was she seen at when she was prescribed the medication? Was it a hospital or a primary care setting? If a hospital, we'll want to take her back to that facility if possible.

[DartmouthDave]

Hello All,

No wheezing are noted in the lung fields. Just course (rhonchi). The swollen ankles are a long standing problem and they don't seem any worse than normal.

The son has no idea what was prescribed. His mother went to see her GP and was given the Rx with a follow up booked in a week.

You transfer to the ambulance, start and IV, give fluid and reassess:

GCS 13-14

HR 140-150 A.Fib

BP 70/40

SpO2 89-90% on 15 lpm

Cheers

[fakingpatience]

How much fluid have you given at this point? Any change in lung sounds? If still no rales present, I'd place her on a duoneb, get out the CPAP if she is alert enough to tolerate it. Can we get a 12 lead? Any known allergies?

I'm leaning towards sepsis caused by possible pneumonia. I'd be cautious with the fluid boluses though due to the possible CHF hx and peripheral edema, however not loving the pressor option with the afib w/ RVR...