DartmouthDave Posted July 28, 2013 Posted July 28, 2013 Hello, The scenario sections has been spammed. Therefore, I think I would like to post an 'actual' scenario based on a recent ICU admission. A sick person call. You are dispatched to a nice suburban home for a 57 year-old male who coughed up blood and a piece of metal two days ago. His mother called an ambulance because she is worried because her son is looking gray. You are greeted at the door by the concerned mother. My son has a soft trachea and he had surgery on it a month ago. He coughed out a piece of metal and has been getting sicker since it happened. You enter the living room and see a thin, frail looking middle age man in a chair. He is coughing and spitting up copious amonts of thick yellow secreations. He looks up weakly and drops his head. Have fun. David
MariB Posted July 28, 2013 Posted July 28, 2013 Sounds like an infection and rejection of whatever they put in there. Als needs involved as if he is gray or pale and likely bleeding he probably needs fluids. How are his lung sounds? Has the blood and secretions been going into his lungs? Temp? O2 SATs? Titrate o2 as needed Swelling in his neck? Deviation of the trachea? Who did the surgery? Have medical direction contact surgeon Rest of vitals in bus. Has pt been vomiting or deficating blood? If temp, how long has fever been there? Pt been able to eat? Swallow? Drink? If not how long? Als needs to be involved with the rest
mobey Posted July 29, 2013 Posted July 29, 2013 What exactly was the surgery? Is he on meds now? Lets sit him up the best we can, start highflow 02 and grab a set of vitals.
MariB Posted July 29, 2013 Posted July 29, 2013 I was guessing a stent of some kind, maybe for stenosis. Unsure of course without more info.
ERDoc Posted July 29, 2013 Posted July 29, 2013 Any pain, trouble breathing, fevers or difficulty with secretions? What was the surgery and why?
mobey Posted July 29, 2013 Posted July 29, 2013 Any... trouble breathing....? It's funny how much I ASSume based off a single post. I'dlike to withhold my high flow 02 until this question gets answered
ERDoc Posted July 29, 2013 Posted July 29, 2013 Eh, it's no biggie. That's the problem with the internet and scenarios. We all get a picture of what we think the pt looks like and incorporate things that may or may not have been there.
DartmouthDave Posted July 29, 2013 Author Posted July 29, 2013 (edited) Hello, His mother has a sheet with her son's medical history and medications. She says it is too complicated for her to keep track of. Her son has Tracheobronchial Malacia and was having trouble brathing and clearing secreations. He had a sent put in two weeks by Thoracics in the big city (3 hours away) ago but things never improved. Plus, HTN, DPL, DM, Asthma, COPD, MI, CHF, depression, anxiety and a suicide attempt a year ago. He is on ASA, Lasix, Ventolin, Atrovent, Digoxin, ACE, SSRI, Ativan PRN and his GP added Prednisone PO awhile back. The patient is very weak and hot to the touch. He is breathing very fast (40's) and he is having a hard time coughing and clearing his secreations. He gestures to his chest and feels burning. His VS are: GCS 14 HR 130 BP 70/30 Temp 40 Resp: 40's SpO2: 84% on RA EKG: old ant. 'q' was and ST elevation in II,III and AVF. Cheers Edited July 29, 2013 by DartmouthDave
MariB Posted July 29, 2013 Posted July 29, 2013 Yikes, Als please. He needs o2. Start transport and intercept als. Vitals every 5 or less, watch the bp closing in.
paramedicmike Posted July 29, 2013 Posted July 29, 2013 Septic, indeed. Any chance you have a field/portable lactate on this patient? ABCs with some aggressive fluid resuscitation is in order.
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