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Rezq304

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Posts posted by Rezq304

    Unresponsive & breathing

    in Education and Training

    Posted

    Forgot to add:

    I agree with jwraider on the need for a very detailed head to toe physical exam. She's not much of a historian given her current condition and the handoff info from the facility/crew seems to be less than voluminous. Any interesting findings on the detailed head-to-toe? Since she was an intercept I know you didn't get the chance to look at the surroundings...this makes the physical exam even more important IMHO.

    Also, does the monitor have etCO2 monitoring? Maybe we can slip in one of the measuring cannulas? If so how does the waveform and numbers look?

    -Trevor

    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.

    Unresponsive & breathing

    in Education and Training

    Posted

    when is the last time that she peed?

    What does her urine look like? Is she catheterized - if she is and shes in a nursing home then 95% probability is that she has a Urinary Tract infection.

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

    Unresponsive & breathing

    in Education and Training

    Posted

    I'm curious as to how (and why) you got an oral temp on an unconscious, unresponsive 92 year old. :?

    Very carefully...oral was the best option at the time & pt did feel afebrile to touch.

    Are you confident in that temp?

    Not very

    And would you consider that a fever?

    No

    Unresponsive & breathing

    in Education and Training

    Posted

    What dust said complete the vitals... SP02 maybe temperature and a detailed assesment.. DCAP_BTLS.. Looking for things we couldn't see while she was in bed under the blankets. FOr example how does this person go to the bathroom? Foley? Diaper? Any info on urine output or bowel movements? How do her legs look?

    Also maybe a better Hx although sometimes a SNF doesn't have a nurse who speaks english can we pretend this one does? =) What was she doing earlier in the day? Activity? oral intake? Are any of these symptons new or are they chronic? (Lung sounds).

    I'm assuming the care at the facility is minimal if their only complaint was she was unresponsive and didn't report on the rest of her condition.

    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.

    Unresponsive & breathing

    in Education and Training

    Posted

    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.

    Unresponsive & breathing

    in Education and Training

    Posted

    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?

    Drug Box

    in Patient Care

    Posted

    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

    Nitro in Right Sided Cardiac Compromise?

    in Patient Care

    Posted

    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:

    Adult IO's

    in General EMS Discussion

    Posted

    I would hope that all ACLS providers are capable of establishing an IV in the patients that would need them instead of relying on a device that buys into the decreasing expectations of providers.

    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.

    Nitro in Right Sided Cardiac Compromise?

    in Patient Care

    Posted

    NTG is not contraindicated in right sided AMI's as many attempt to claim. Now, with that said, it would be illogical to administer it to a patient and potentially cause a hypotensive event and thus increasing oxygen demand and potentially increasing infarct size.

    I personally rather obtain a XII lead prior to any NTG administration, to prevent administration to a right sided or inferior wall AMI. It does not take long to obtain, and by the time ASA therapy begins, my ECG should be accomplished.

    Usually, (not always) one might see lower blood pressures associated with inferior wall, but not necessarily so. I personally still withhold NTG in such cases. In non-right side AMI, I prefer to keep them slightly normotensive ot slightly hypotensive (the old CCU nurse in me) and have no problems administering NTG with systolic pressures > 90 mm/hg.

    I have found a slight bolus (250 ml) or so actually increases preload in some right sided AMI and will actually decrease their pain. The old saying, if NTG and Morphine is making the pain worse, give some fluid and check to see if you have a right sided AMI.

    R/r 911

    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.

    EZ-IO Drill

    in Patient Care

    Posted

    My service put the EZ -IO drill on the trucks earlier this year. A great tool in my opinion. Has anyone else had any experience with these?

    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.

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