ERDoc Posted July 18, 2007 Posted July 18, 2007 You are called to the local nursing home for a pt that is hypotensive. The nurse that is waiting for you at the door (hey, it could happen) tells you that the pt was discharged from the hospital 2 days ago. He has a h/o Parkinsons and has difficulty verbalizing anything more than yes/no, but he can fully understand what is said to him. He is currently on Levaquin for pneumonia (which is why he was admitted to the hospital about a week ago). They tell you that when they woke him up to check his vitals, his BP was 70/42. What else do you want to know?
MeekoBB Posted July 18, 2007 Posted July 18, 2007 Any other signs or symptons? Allergies? Other meds? Have they fed him? New events, therapy, any thing outside of normal activities? Does he have any pain or discomfort thats not normal for him? Is he in a private room (sometimes a roommate could be the source of a problem)? What are the vitals EMS takes? General impression? ETA: Just did some brush up reading on parkinsons, dopamine related drugs can increase orthostatic hypotension. does that relate to the situation at all? trying to think of other questions I would ask myself if I walked in on that...
ERDoc Posted July 18, 2007 Author Posted July 18, 2007 Any other signs or symptons? Allergies? Other meds? Have they fed him? New events, therapy, any thing outside of normal activities? Does he have any pain or discomfort thats not normal for him? Is he in a private room (sometimes a roommate could be the source of a problem)? What are the vitals EMS takes? General impression? ETA: Just did some brush up reading on parkinsons, dopamine related drugs can increase orthostatic hypotension. does that relate to the situation at all? trying to think of other questions I would ask myself if I walked in on that... The pt denies being in pain. He did vomit once this morning. He denies being nauseous now. He has not had breakfast due to the vomitting. He is in a private room. He has been bed confined since being hospitalized due to deconditioning and the Parkinsons. Other than the Levaquin he is on no new meds and his doses have not been changed. Your vitals are 62/30, 68, 16, 96%RA. He has NKA and is on atenolol, simvastatin, plavix, Levaquin and Sinemet.
MeekoBB Posted July 18, 2007 Posted July 18, 2007 Okay, trying to familiarize myself with medications as I plan on going for medic next Fall.... Sinemet is for the Parkinson's, I just read about levadopa being the main line treatment for it. Plavix is a blood thinner, cardiac hx? Levaquin, an antibiotic, known personally Simvastatin, had to look up, lowers cholesterol for those at risk for cardiac or stroke atenolol, looked up as well, beta-blocker, again, cardiac hx? How long ago was the nurse's vitals prior to EMS's set? Establishing time frame for the decrease, continuous vitals (I would do). As BLS, I would load the patient for transport, and request ALS for the decreasing BP pending ETA to ER. Sorry, if I annoy anyone with my post, trying to get into the senarios more and I listed the meds and reasons for them so I can as well as others in my situation knows what they are for specifically, although many of them are well beyond my education.
AZCEP Posted July 18, 2007 Posted July 18, 2007 Blood glucose? ECG? Is it possible the patient got a double dose of his atenolol?
ERDoc Posted July 18, 2007 Author Posted July 18, 2007 No abnormal med administration. Pt has h/o htn as well as an MI about 20 years ago. He denies any chest pain or trouble breathing. FS is 115.
rocket Posted July 18, 2007 Posted July 18, 2007 I too was wondering about the beta blocker and how it might be figuring into things here. At the least it may be holding back reflex tachycardia. Quick question: He has a Hx of Htn, and the folks at the nursing home called us primarily because of his hypotension so they should have a pretty good record of his BP and other vitals. What are the 'baseline" vitals for this patient per the staff? I'd like to know how far off this guy is from his normal numbers. Oh and can we get a temp on him too? I understand that given his age and condition he may not show a fever but then again you can't find a fever unless you take a temp... -Trevor
ERDoc Posted July 18, 2007 Author Posted July 18, 2007 The nurse tells you that his BP has been running 110-130/70-90 since he has been at the NH. His temp is 98.3 tympanic.
rocket Posted July 18, 2007 Posted July 18, 2007 Thanks! 8) If there have been no changes in meds (other than the addition of the Levaquin) then I assume the guy is still on Plavix? Perhaps a bleed is the culprit here? Let's do a few things: (1) If we haven't already, can we check the BP on both arms to see if they are congruent. Are pulses good in all extremities? (2) See if the guy looks pale. Ask the staff if he looks any different than normal. While we're at it let's take a look at the conjunctiva too. (3) Find out if the vomiting is something new or if it has been happening all along. If anyone saw it I'd like to know what it looked like. (4) Let's perform an abdominal exam. What are the findings? -Trevor
Just Plain Ruff Posted July 18, 2007 Posted July 18, 2007 How bout taking a look at his stool? Maybe his diaper (which every bedridden nursing home patient should wear) has some stool in it? what color is it? How bought the color of the emesis - bloody or not?
Recommended Posts