brock8024

Ok I had a eye opener of a call a few weeks ago. It was one that could have went really bad very fast. Here is the over view of what happened. 40 year old african american female with complaints of chest pain. When me and my partner got there she was sitting on the side of her bed and would not answer our questions. Her husband was very nice and would give us the best hx he could. Our pt would shake her head yes and no and everyone once in a while speak very soft. The chest pain was always a 6 or 7 out of 10. The pain radiated to her back, under her clavicles and up her jaw. Her only hx was abscess tooth 3 days prior and was on treatment for that. We get her to the truck and notice that her neck looks like she has a goiter. It was kind of swollen looking but our pt is 5'5 or so and is about 250 or so. She is hypertensive and her spo2 is low around 91 or so. Place her on some oxygen, notice she is sinus tach about 120's. When she does try to talk we noticed that she drooled a little. Was unable to get a IV, which was no surprise she told us they normally have to place a triple luman. We was just about 3 mins from ER. Got her there they knew her. The ER doctor also noticed her neck. Pt was worked up for Chest pain for sure and was then rushed to the OR to be intubated. Why was this pt intubated? Well she had a very life threating condition. It was caused due to her abscess tooth. The pt's airway was about 50% blocked off and very easily been all the way and needed to be trached in the field. Well I have told you the story now lets see if someone can come up with what was wrong with this pt. It is a good learning case. I put it under pt care because there are many times that we think oh a toothache but it can turn into a deadly thing for your pt. So I know what was wrong and I know dust does too. So someone post what was wrong with my pt.

No temp just warm to touch. Her tongue seemed to be pushed forward. JUst meds for abscess. No headache just the chest pain and back pain. Your pt does not give a reason why she will not talk just that she drools when she does.

bump

I have had my moments of tearing up, being heartborken and asking why. But that was the first time I had actually cried. I think it was a way of me being shown that I am human still. I mean we sometimes try nto to let things bother us. I know I had been questioning if this is what I was suppose to do in life. It i wanted to cont being on the truck. I think it was a way for me to realize that I need to follow my gut if I get a huge gut feeling and that it is ok to cry everyonce in a while. I did not lose it in front of the family just at my truck alone. After i had i was fine and have been since.

What is his abd like. Is it soft or hard, tender or non????

12 lead or EKG. He could be ihaving a AMI.

I think my biggest thing was how it was at the ER. My boss was there and he was like well she is hyperventilating when we opened the doors. Now when we pulled her out he agreed with my dx of PE. We got her in the er and I gave my report to the nurses and Doctor. We was called for NVD for 5 days. He was thinking it was extreme dehydration. I was talking to him and told him my gut said PE. well Like I said 5 mins later they are coding her and she died. I think my biggest thing is My gut said one thing and just the commemt my boss made and how the doc was not thinking the same as me, I mean I am not a doc but you know. And then she dies. I was thinking I done something wrong or if they had listened. My boss did not mean what he said in a bad way because once he seen her out of the truck he knew we was right. The doc I am sure had that in the back of his mind but you know. Btw we me and my partner was told that her clot was huge. I mean at least 6 inches long. THere is nothing or no one that could have saved her. Me and my partner who is a basic but I respect very much. As a matter of fact there is no rank on our truck. We have come up with a great way of handling calls together. We review S/S and talk bout different meds and things. I will ask her what she is thinking and if it is different then what I am we talk about it. I have like everyone else been wrong. We have talked many times about the presentation of PE and this girl was text book. BUt i cried for my 2 mins and was fine. Hell we even joked bout the ripper being in the bathroom with us and tripping us up. We had trouble getting her out of the bathroom. I am fine now just wondering if others done this.

OK so two shifts ago I done something I had never done before. I went back out to my truck and actually cried. Yes I am a Male and I CRIED. I had a 26 year old female pt that I had taken into the ER and she died 4 or 5 mins after I got her there. Me and my partner talk and go over different dx and S/S. Well this girl had a huge I mean HUGE PE. So has anyone ever had a crying moment.??

Lung sounds are??? I am thinking PE,Mucus plug, pneumonia, sepsis. I am leaning more towards the PE or mucus plug. He has been in bed for 3 weeks after surgery and probly not moving much. I would ask and see if he is on any blood thinning type meds. Pt with trachs that can not cough well or are dehydrated can get plugs deep in bronchials and have to come out.

what else u want to know?????

is vent working and last time he was suctioned? Skin signs, vitals, meds, hx.

No hx of thyroid problems. She has no N/V/D.

My Bad, She is on HCTZ, Lisinopril, ASA, Augmentent (sp).

It is actually looks like a normal neck for a person that is overweight. you palpate and feels a little firm. Pt feels alittle warm to touch. Pt states that she has felt ill due to the abscess. When she finally does talk to you in the back of the truck you notice her wiping her mouth alot.

NKDA and her list is already listed

You noticed when looking for the JVD that her neck seemed a little swollen like a goiter but hard to tell since she is 5'7 and 240.

Ok you get her to the ER and the EKG is sinus tach at 118.

No change in pain with position change.

You not that there is swelling in the jaw. She was able to walk to cot. No blurred vision,no headache, no tinnitus. Equal grips, no recent surgerys, non smoker, been walking normal. she was asleep with this woke her up.

She wants to sit semi-fowlers. Stent was placed about 5 months ago and abcess for about 3 days.

Lungs CTA bilat, Little demished in bases. BP- 180/92. No JVD, No edema noted. No other injuries or strains. Pain does increase with deep breathing. Oxygen works and your up to 97%. IV after 3 attempts. ASA given.

HR-120 reg, 24 RR slightly labored, 93% RA, sinus tach on monitor. I work rural EMS so no 12 -lead til hospital. Chest pain woke her up. She states it is a 5 to 6 out of 10, after asking and head nods it is a sharp pain sometimes presure. IT radiates from substeranl to right side of chest and to back and up neck. When you palpate it hurts more. She has been fine jsut the abscess tooth. She takes her meds and has NKDA. she takes the above meds listed.

Pt is able to speak some just seems like she does not want too. Husband states that she woke him up with chest pain about 10 mins prior to calling EMS. Pt has a hx of HTN, stent placement, and abscess tooth a few days ago and is rx for that. Pt will answer with head nods and speaks some but seems like she is just wanting to be difficult. At first she just looks at you the points to husband but with some coaxing she will speak.

come on guys and gals. this was actually a intersting case.

Responding unit is ALS 5 mins nearest ER and 45 with Cath I wish I could hit the Snooze 40 year old overweight black female. Skin dry,warm,pink. RR 24 non labored. Pt does not answer your questions. She looks at you then husband so he will talk to u.