Rezq304

Yeah, nothing really special about this scenario, just wanted to use this avenue to share the quality of the SNF's in this area. Pretty sure Dx of Hypoglycemia secondary to UTI. I'll swing back by the ER today to confirm.

Volunteer truck not equipped with etCO[sub:9b0b66397d]2[/sub:9b0b66397d]. Nothing notable on head to toe other than pale diaphoretic skin. Pupils were equal, but sluggish. Trach mid-line, (-) JVD. Chest unremarkable. Equal bilateral radial pulses corresponding with carotid pulse. Equal pedal pulses. No noted bruising. Positive response on Babinsky test.

Pt was not cathed. SNF unable to tell anything about last urination. Pt had minimal PO intake for about a week.

Very carefully...oral was the best option at the time & pt did feel afebrile to touch. Not very No

Only report given was minimal. I ran this as an ALS intercept for a BLS truck. They asked the majority of the questions posed to me & were not given an answer.

I apoligize, SpO2 of 92% on RA. SpO2 up to 99% on 15L O[sub:7a2fbddd32]2[/sub:7a2fbddd32] by NRB. Temp orally of 99.1[sup:7a2fbddd32]o[/sup:7a2fbddd32]. Lung sounds do not improve upon placing patient in full fowler's position. Repeat BGL after Dextrose of 184. DNR is on board, but your patient is not in cardiac arrest. Patient begins to become alert to voice when you note a small section on her paperwork that denotes her med Hx to include Alzheimer's & Dementia. Still looking for a complete meds list that would've clued you into this sooner. No Hx of Diabetes and no Hx of Insulin admin.

Pulse-62 BP-90/60 Resps-24 Lungs-Rhonchi noted at the bases, Wheezing in the upper Monitor-SR with (-) Ectopy or ST Changes BGL-21 (+) Diaphoreses Hx-CHF, COPD, Asthma NKDA Meds-Atenolol, Lisinopril, Albuterol, Atrovent (-) Response to painful stimuli What else?

You are dispatched to a SNF for a 92yo female, unresponsive & breathing. Call received at 1800. Pt has been unresponsive since 1530.

Curious about the 12-Lead also. Use of MDI's?

Epi 1:1000 Epi 1:10000 Epi Pen Epi Pen Jr. Atropine Lidocaine Haldol NTG Tabs Dopamine Sodium Bicarb Morphine Vasopressin Magnesium Sulfate Valium D50 Glucagon Amiodarone Albuterol Lasix Benedryl Solu-Medrol Adenosine ASA Naloxone Phenergan

Responding to letsgonational. If you give NTG alone to a right sided MI, you completely knock out the preload for this patient. Incidentally, the preload is the only thing keeping blood circulating through the body because the right ventricle is the location of the infarct. A right ventricle that doesn't work means that it cannot pump blood to the pulmonary circulation for oxygenation, therefore knocking out any systemic circulation. But, in all honesty, you'll get good practice with CPR doing this. :wink:

That was my first thought

Understatement of the Year!

You can't hurt the guy by bagging him. If all else fails, err on the side of caution.

Good luck with that. Ebay would probably be her best bet, but I just checked & none were listed.

AZ, I agree that it becomes a crutch for provider's that aren't the best at gettting an IV. But, on the other hand, it is a nice quick option for those that you just absolutely can't get an IV on.

Have we really come to alluding to Leslie Neilson & "Airplane"?!?!?!

My feelings exactly Rid. If I have the equipment available to me, why not go straight for a 12-lead. Takes less than 60 seconds to obtain & can prevent NTG administration to a normo-tensive patient where the right ventricle is compromised.

Can I adequately manage pain? That's a double edged sword. For some yes, for others no. I had a girl with an obvious tib/fib Fx that got a total of aobut 20mg of Morphine with no relief. On the other hand, I had another girl with a broken ankle where 2mg Morphine & 12.5 of Phenergan put her on "cloud nine".

Yes, my service has been using the EZ-IO for about six months now. Numerous lines have been place. I've not had a bit of trouble out of it as of this date. The only situation I've seen the EZIO not work was on a mobidly obese patient & the cathater wasn't long enough to go through the flesh & the bone. Definitely think it's a much needed asset & serves as a good "last line" means of gaining IV access.

LOL....nah, it'll give the kid something to do.

As always AZCEP, spot on!

May be the "cold" answer, but I gotta say I agree with AZCEP on this one.