JasonA

I forgot to get back to yall and tell you what she said. #1. CHF #2. MI #3. Croup or Epilogottis Thanks for all your help.

Ah, I hadnt thought about that. I am going to need something to fill in the time till I can start riding an ambulance. No one hires 19 y/os.

Staphelo what? Etiology? :roll: I thought we were talking about not getting into figureing out what it was, now you guys are trying to figure out which nasty little bug it could be. Thanks again for all your time. Now I just hope we have class tongiht. 6inches of snow and its still snowing! YAY!

SCOPE! Dont confuse me! I think I am going to have to stick with TB for the first one. For one, it explains her cough. She also has a history of heart problems. Knowing my instructor, she wouldnt give us two heart problems at the same time. TB kinda feels right. You are right, I did miss the boat. I was trying to make it way too complicated, and out of ignorance, didn't see what was really going on. I will argue with you on the have for croup. If I remember having croup, then it had to be when I was somewhere in the 4-6 range. Maybe a little older. Just shows ya that is doesnt always follow the book. You threw out a bunch of information that is alittle out of my range, and I am sure we wont cover. So, thanks. The more I learn the better.

NC, From your advice, and comparing it to what the book has on both of them, I went ahead and put "Possible Croup ( Maybe Epilogttits). Its not graded, so I am not worried about it. I remeber having croup once, and my parents said I had it a couple of times when I was really tiny. Ah, good times. Setting in a steamy bathroom, then outside when it was freezing. On #2 I just went with an MI. Since he is on Lasix that does mean he has a history of heart issues. As an EMT-B, not being able to give Lasix, it isn't really important to figure out which one. Thanks again! (It looks like we are going to get snow again Thurs-Friday, so I might not have class anyway. Too bad I cant decide not to show up for appointments just because it is snowy. )

We are using: Emergency Care and Transport of the Sick and Injured Jones ane Bartlett Publishers There website for the book is www.EMTB.com This is the first time we have ever done something like this. Generally out scenarios are more simple, and try and get us into assessing, not so much diagnostic. Could you guys give me an idea of what you think would be the most important things to cover, so atleast I can be working on it on my own? Edit: I checked again, and there is only that one little thing about TB. I will admit that #2 was just me making things to complicated, the first thing I thought of was MI. I just moved on and got confuzzled.

Ok. The first time I read it I wasnt sure what you meant, I see now. Thanks for all of your help! Ok, one more question. Doesnt sepsis present with red, hot, and sweaty skin? Also, wouldnt he be coughing if it was pneumonia?

I couldn't agree more, Vent. A former EMT that I talk to allot has told me a bunch of times to never, ever assume what is going on. Even if you know with out a doubt, always say "Possible......" He always says to manage life threats, and leave the fixing to the doctors. I do see that it helps having atleast an idea of what is possibly going on, or what the person might have. But, this is EMT-B class. The instructor is in charge, and it isn't my place to question her, too much. She wants to know what we think, so thats what I am trying to do. IF it is TB that you are thinking #1 could be, I checked to see what was said about it in our book. It was in the "Protecting Yourself" portion and said that the PT would have a cough, and you needed a mask. That was about it. It didn't even cover it in "Airway" or "Respiratory Emergencies". #1: TB? #2: MI #3: Croup/epiglottitis

That seems to cover most of case #1, right? Hm...I kinda wish now that we had talked about some of this stuff. The signs of tuberculosis may not appear to be serious at first. They include: * Coughing, which produces a small amount of green or yellow sputum in the morning. As the disease gets worse, the sputum may be streaked with small amounts of blood. * Cold night sweats, which are heavy enough to wake a sleeper up and require a change of nightclothes or bed sheets * Not feeling well in general * A loss of energy and appetite * Weight loss over time * Sudden shortness of breath along with chest pain may be a sign that air or fluid has entered the space between the lungs and the chest wall (pneumothorax). For many people this is the first sign that leads them to seek a diagnosis. * Fatigue * Poor appetite * Fevers that come and go * Sweats * Weight loss in some cases * Pain

Could #1 be TB? We really didn't cover respiratory diseases at all. I don't even remember covering TB, just reading a little about it in the book. The most common cause of ascites, from what I have read, it hepatic(Spelling?) failure. Which is liver failure, right? I kinda passed over that because it is out of our scope of practice, I think.

Edit: I was setting her typing this when you posted that message above. So, #1 Possible pneumonia #2 Possible MI #3 Croup or epiglottitis I went back and read over the cases again, and figured out what was making me so confused. I was going through the whole thing and picking out sign/symptoms and trying to figure out what linked them all together. I shouldn't have gotten so distracted by all of the other information and concentrated on each patients Chief Complaint, and then checked the other information to back up my original feeling. I remember that it did say in the book that women, and older men that have MI's present that way. That was my first thought, but like I said, I got so distracted that I never went back and thought more about it. So, as usual, I just need to talk it out and slap myself around a little bit. Thanks for all your time.

Pnumonia? Would whatever respritory disease you are thinking of account for the rest of her symptoms? On #2 my very first though was possible MI. The epistaxis threw me off though, could that just have happened? And have nothing to do with the current issue? Also, isnt his MDI ussages a little excesive, and should that be kept in mind? On #3, croup is possible. But would that account for the drooling? 3 y/os dont drool. I am sure that I should have picked it out right off. But my experiance is limited to what I have read in the book, and it has all been thrown at us so quick I am a little overwhelmed. So, Im sorry if it seems like I have no idea, I am just a student, and I really dont. It seems like there are so many things it could be, and especialy with #1, she has so many things wrong. How do you chose what is caused by what, and what the main problem is.

You got EXACTLY what I got. I did correct a few of her spelling errors, but that is it. We are doing Pediatrics/Geriatrics, so I think that she meant the daughter in the last one. Unless being a mom is a serious medical condition, it would be usless information if you were talking about the mother. Thanks for what you have come up with so far. I will be going over them again after I have thought about them more. NCmedic, I am not really sure what you mean.

We were talking about #1 in the chat. Is it possible that that prevalant condition is Hypovolemia/Dehydration due to the Lasix? That would account for the high HR, RR, as well as the lowered LOC. Weakness is in there too. The BP is high for compensated shock, but the is on Lipitor and Crestor. Then again, if she is a CHFer, would it even be possible for it to be high? Cyanonis from poor perfusion, and the sunken eyes. Are abd pain and nauseous a sign of dehydration? Or would you think that would be from the ASA?

My instructor canceled class, again. So she sent us these case studies. We are not going to be graded on them, so its ok to help me. She said that we are going to talk about them tomarrow night in class, but, for reasons that I would like to keep to myself, I would rather yall go over what I think first. How is my logic? Oh, and I know, she is not good at spelling or gramar, but you can get the idea. The last two I feel really confident about. The first one.... :shock: :scratch: Case Study 1 You respond to a 52 y.o. woman complaining of dyspnea, especially bad at night accompanied by a nocturnal productive cough and fatigue. Your general impression is that he is “sick”. You patient assessment reveals that she is tachypneic at 32/min and tachycardic at 110/min. She is also hypertensive at 162/102, A & O x 3 and confused, slightly pale with cyanotic lips, PERRL and has good sensory, motor and a cap-refill or 4 seconds. She feels nauseous, has some abdominal pain, sunken eyes, is weak and has been urinating frequently. She has not had much of an appetite but has been drinking tea, water and some hot chocolate. She is allergic to sulpha drugs, takes lipitor 10 mg, lasix 10 mg and crestor 5 mg daily for hypertension and high cholesterol. She is also diabetic type II and her BG levels read 72. She also takes nitroglycerine for her heart when needed and one baby aspirin daily. Upon auscultation you detect rales her lower lobes. What is her condition and what is your treatment? Possible Hypoglycemia/CHF This patient is possibly hypoglycemic, as shown by a BGL of 72. It is possible that hypoglycemia is the cause of all of her signs/symptoms. Lowered LOC, confusion, and abdominal pain are signs of hypoglycemia. It is possible that she has chronically overdosed on Aspirin. As that would account for most of her signs and symptoms. She does have possible CHF, which would account for the rales, cyanosis, cough and dyspnea. Her mental status could be altereted due to hypoxia. I feel that it would not be wise to try and decided which one is the cause. I would transport with highflow 02, and consider D50 or an alternate method of raiseing her BGL. Case Study 2 You respond to an 80 y.o. man complaining of weakness. Your patient assessment reveals that he is tachycardic at 122/min, tachypneic at 36/min, A & O x 4, diaphoretic, pale, cool and clammy, peripheral edema, ascites and had a bout of epistaxis last night. He is allergic to penicillin, is on Zocor daily, Nitrostat when needed, has a nitro patch, baby aspirin daily, Albuterol 2 puffs morning and night, Flovent 1 puff morning and night, 40 mg lasix and a fiber pill daily. He has not had much of an appetite but has been drinking plenty of fluids. What is his condition and what is your treatment? Possible over-use of MDI Weakness could be any number of things; age related, heart or lung related, it is also possibly an effect of the MDI usage. Tachycardia is a side effect of Albuterol, as is tachypnea. Pale, cool, and clammy skin is an effect of Albuterol, is could also be from his under-lying heart condition. Peripheral edema and ascites are most likely per-existing conditions, and have no relevance to the current situation. This is evidenced by his use of Zocor, Nitrostat, Aspirin, Lasix, and a nitro patch. Epistaxis is a side-effect of Albuterol, as is loss of appetite. His use of two MDIs daily is concerning. In general only one should be used daily, with a fast acting inhaler for sudden onset of symptoms. Interventions is this situation are limited to high-flow 02 via a non-rebreather mask at 15lmp. Transport. Case Study 3 You respond to a 3 y.o. female who’s mother is complaining of dyspnea accompanied by a harsh high-pitched cough. You patient assessment reveals that she appears sick is tachypneic at 38/min, tachycardic at 118/min normal blood pressure, is running a fever of 102 degrees has a cough and is drooling and is pale and has cyanotic lips. She is also congested and has signs and symptoms of a cold. What is her condition and what is your treatment? Possible Epiglottis The harsh, high pitched, cough is suggestive of an upper-airway obstruction. The elevated respiration rate suggests insufficient respiratory function. The heart rate is within normal limits for a 3 year old. Fever, cough, and the signs/symptoms of a cold are all consistent with Epiglottis. Drooling is cause by the in-ability to swallow. Cyanosis is cause by the airway being obstructed. Pale is a sign of being sick, also of cyanosis. There is not much an EMT-B can do in this situation. Provide high-flow 02, via a non-rebreather mask at 15lpm. Transport in a position of comfort. Be ready to provide ventilation via BVM should respirations become even more insufficient.