northernmedic Posted April 20, 2006 Posted April 20, 2006 Th ebest thing you can probably do for this guy at a PCP level is assist ventilations with a BVM to lower his blood pressure via the respiratory pump mechanism and increase his intraalveolar pressures. Cardiac asthma is almost never ruled in or out by auscultation findings alone. The biggest indicators in this pt will be the history. Does he have: SOB on exertion? PND? Orthopnea? New onset nocturia? The elderly are rarely diagnosed with asthma (usually a misdaignosis by their GP) Is he a smoker/COPD Hx? Any cough, in particular non-productive or whitish? Fever/chills/pleuritic CP to indicate pneumonia? He most likely has a Hx of hypertension as well. Any drugs like ACE inhibitors/beta blockers/CCB's etc should really raise you index of suspicion. What is his I:E ratio? He is also hypoxemic, tachycardic, diaphoretic and hypertensive. While not unique to CHF it certainly raises my index of suspicion right away. Giving this pt epi will probably kill him or at least make him seriously sick. The last thing this guy needs is more afterload and a higher myocardial oxygen demand. Moving this pt is going to be tricky and will need to be very gentle so his dyspnea is not aggravated.
TechMedic05 Posted April 21, 2006 Posted April 21, 2006 Unfortunately, we were given very limited PMHx in this scenario, although still lots can be determined by just looking at your patient.
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