scope2776 Posted May 15, 2007 Author Posted May 15, 2007 DIB is in fact "Difficulty in Breathing" sorry for any confusion.... You immediately take the paper bag off the girl's face, to which the "nurse" replies, "Why did you do that? It was making her better!" In fact, in the time since you have arrived the child breathing seemed to be slowing down and the girl seemed to be relaxing, becoming almost drowsy. Your EMT partner places the pt on 15 LPM NRB and takes some vitals as you instruct the nurse to gather any medical information about the girl. VS are: R: 30, BP: 90/60, and pulse is "too fast to feel" maybe 200 or 250 "I can't tell". The girl is still awake, and the slightest bit drowsy, and still breathing fast with the NRB. No signs of cyanosis or retractions, though the girls is obviously working hard to breath. A little sweat is starting to form on the girls forehead, other than that skin is unremarkable. Your EMT has a look at the pupils as you put on the pulse oximeter. Pupils are PPEARL and pulse ox reads 88%. The nurse returns with a few copied papers and hands them to you. One is a consent to treat for emergencies, signed by the pt's parents, another is a history sheet that reads, "NKDA" and states no prior medical history. The "nurse" asks, "why don't you just take her to the hospital already? Teach her a lesson." The principal asks why you aren't listening to his "nurse". Your squad has recently ungraded their LP 12's to the capnography function. Your partner asks if you'd like him to apply the detector under the NRB? You ask the girl if she is allergic to anything to which she replies, "no". You ask if she has been stung by a bee or been outside, she says, "no". You ask if she has asthma, she says, "yes"........... "only"........... "when"............... "I play"................. "sports"............... After working so hard to speak, she concentrates solely on breathing, almost having to gulp for air. You ask about an inhaler and she says after a minute or so, " at home". You ask if she is on other medications and after another minute of breathing she states, "yes".................... "birth".......................... "control". You ask, "Do you smoke?" She says, "no". The nurse says the girls was complaining of her "heart beating fast" after she heard of her failing grade. You look at the young woman and she nods her head in agreement. You ask about chest pain and she also nods "yes". And after instruction holds up 1 finger to quantify. Physical exam reveals no DCAP-BTLS. What next?
Just Plain Ruff Posted May 15, 2007 Posted May 15, 2007 birth control pills would lead me into a blood clot causing this. I'd probably iv o2, monitor and such. Take her to the er. She may just be hyperventillating but let's play it safe.
WendyT Posted May 15, 2007 Posted May 15, 2007 You said the school is fairly new, I would say it has to do with the new smells and this could be causing her some problems. It could also be stress from failing or she just found out she is pregnant
spenac Posted May 15, 2007 Posted May 15, 2007 or she just found out she is pregnant Hey now thats getting into my area of thought as I run the stork ambulance.
cfaulknor Posted May 15, 2007 Posted May 15, 2007 Lung Sounds? If there is wheezing, Albuterol Neb.... If that doesn't work... I'd want to hook her up to the heart monitor... Attempt vagal manuvers Establish IV If fixing the breathing doesn't work, treat arrhythmia if present... Atrial Tach maybe?
nick46928 Posted May 15, 2007 Posted May 15, 2007 Lung Sounds? If there is wheezing, Albuterol Neb.... If that doesn't work... I'd want to hook her up to the heart monitor... Attempt vagal manuvers Establish IV If fixing the breathing doesn't work, treat arrhythmia if present... Atrial Tach maybe? I thought that atrial tach(or any tachycardia other than sinus tach) was a contraindication for albuterol. Don't want to increase the rate even more.
cfaulknor Posted May 15, 2007 Posted May 15, 2007 not if the tachycardia is due to the breathing problem... if the albuterol resolves the breathing problem, and the breathing problem is causing the tach, then it should be fine... if not, then we won't hear wheezes, so the albuterol won't be used... either way
nick46928 Posted May 15, 2007 Posted May 15, 2007 Duh. That makes sense. I don't know why I didn't connect the two problems. I need to get some sleep. Insomnia is affecting my reasoning.
p3medic Posted May 15, 2007 Posted May 15, 2007 a heart rate of 200-250 is not likely a result of her "asthma" fix her heart rate and i bet her breathing gets a whole lot better...and her anxiety too 8)
nick46928 Posted May 15, 2007 Posted May 15, 2007 Which came first, the chicken or the egg? It could be either.
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