mfprincess

Clearly dear you are not mentally equiped to handle emergencies. Seemingly heathy 27 year olds can have lethal arrhythmias. Arrythimias can look like seizure activity, that is why a AED should have been placed on the poor man who lay there dying without much needed oxygen. The best thing you could have done was called 9-1-1 and yelled at the top of your lungs "does anyone know cpr". The 9-1-1 operator can also give you CPR instruction over the phone, I did'nt see you mention that someone called.

If you are going to open up your own personal training facility might I suggest buying a wall poster with the instructions and pictures written out that you may post on a wall. You can purchase that from the American Heart Association. Having obese patients and those with high blood pressure is very risky without having equipment at your dispossal ie: blood pressure cuff, pulse oxymetry. These people are in a very high risk category and you are asking for trouble. I'm sorry if I sound cold and unsympathetic but you providing CPR may be the difference between life and death. Clearly you see this or you would'nt be losing sleep over the 27 year old who is still intubated and may have suffered permanant brain damage from his lack of oxygen. Good luck with your studio and please consider sitting it on a CPR course to refresh or relearn these important skills. just know that it only takes 6 minutes for the brain to begin dying without oxygen and the ambulance may take longer than that.

Hello,

You are dispatched to a rurual home 30km from town for SOB.

Upon arrival you find a 55 year-old frail looking female in obvious distress. She is hunched forward, tachypenic, and using assessory muscles. Her colour is pale. She is very anxious.

She is surrounded by a large and loving family that is on the verge of panic. Her husband states that he wanted to call an ambulance yesterday but his wife wouldn't let him. He says that she has cancer (lymphomas)and that she has been getting cytotoxic therapy and has been going down hill over the past three days. She has not voided for the past 24 hours.

On exam;

GCS 15

BP 190/110

HR 120 irregular/bounding

Temp 39

Generalized pitting edema. Lungs have course crackles in all lobes. Elevated JVD. A PICC line is note in her right arm. An old surgical scar is noted in her lumbar region (Laminectomy).

Her past medical history is obtained from the husband. Her history includes lower back pain and a Laminectomy 5 years ago. Lymphomas with some renal issues. The husband can not remember more about her renal issues.

Her current midications are Colace BID, Hydromorphone 2mg PRN, Allopurinol 400mp BID, Ativan 1mg SL PRN, Venalfaxine 150mg OD and Immovaine 15mg QHS.

What would you do and why?

Cheers....

The patient appears to be in flash pulmonary edema (CHF). CPAP is definately indicated, nitro paste, lasix which may not be usefull since the patient is most likely also in renal failure. It will be very difficult to manage this patient in the field so rapid transport to a facility that can handle her multiple medical issues is indicated.