ERDoc Posted December 16, 2007 Share Posted December 16, 2007 You are called to the residence of a 69 year old woman who is feeling weak and dizzy. This has been getting progressivley worse over the past 2 days. She has a PMH of CAD, CHF and DM. She is on ASA, Lasix, Kdur, Digoxin, ntg prn. No allergies. What else do you want to know? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 16, 2007 Share Posted December 16, 2007 General impression? (Sitting, laying, Skin condition, emotional state?) Mental status? Is she compliant with her meds? Has she taken any nitro? When, how many? Vitals, including lung sounds, SPO2, BGL? While that's working let's put her on O2 titrating SPO2 to mid-high 90s, and get the monitor set up and attached. I'll leave it at that for my turn... Dwayne Link to comment Share on other sites More sharing options...
ERDoc Posted December 16, 2007 Author Share Posted December 16, 2007 General impression? (Sitting, laying, Skin condition, emotional state?) Sitting in a chair, calm, nontoxic appearing, skin warm and dry Mental status? A&O to however many points you use Is she compliant with her meds? Yup Has she taken any nitro? When, how many? She looks at you funny, "I don't have any chest pain. I'm dizzy and nitro makes you more dizzy. You must be one of those ambulance drivers that didn't get 50 years of BLS experience first. So, no I didn't take any nitro." :wink: Vitals, including lung sounds, SPO2, BGL? Lungs are clear b/l with good air entry. Sat is 98% on room air. Blood sugar is 152. BP 102/64, P 92, RR 16 unlabored. While that's working let's put her on O2 titrating SPO2 to mid-high 90s, and get the monitor set up and attached. Since she is at 98% already, we will put her on 6L NC unless someone objects. Your partner has set up the monitor and wants to know if you would like him to attach it to the patient. Link to comment Share on other sites More sharing options...
unknown Posted December 16, 2007 Share Posted December 16, 2007 One word: Digoxin -- I say toxicity....... But what do I know I am just a comm spec.......... Link to comment Share on other sites More sharing options...
Niftymedi911 Posted December 16, 2007 Share Posted December 16, 2007 90 to 1 its toxicity i agree, but just in case.......... Orthostatic + or -?? Rhythm strip??? Stroke scale?? 12 lead??? 6L of o's??? your cause her to have a nosebleed by time you get her to the ED. 2 or 3 lpm sounds much better. Link to comment Share on other sites More sharing options...
p3medic Posted December 16, 2007 Share Posted December 16, 2007 Dig toxicity, while on the radar, is very rare these days. Lets see how the rest of our exam pans out. Link to comment Share on other sites More sharing options...
spenac Posted December 16, 2007 Share Posted December 16, 2007 Any nausea or vomitting? Skin? Color (normal, pale, red, etc ), tenting, etc. Fever? Gas for heat/cooking? Does she have carbon monoxide detector? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 16, 2007 Share Posted December 16, 2007 She looks at you funny, "I don't have any chest pain. I'm dizzy and nitro makes you more dizzy. You must be one of those ambulance drivers that didn't get 50 years of BLS experience first. So, no I didn't take any nitro." :wink: You know, I knew I was leaving my pee pee out to get slapped with this question (Sorry, old Cheech and Chong reference), as it certainly doesn't appear indicated here. But with only 150 calls or so that I've teched, I've discovered that even perfectly logical people can make illogical choices when they start to feel hinky. We had a lady with uncontrollable n/v post knee replacement x 3 weeks. She had been doing fine on her pain meds (I can't remember now what flavor) initially, yet after about week two she started to feel sick when taking them. She decided that perhaps she was getting used to them, thus needed higher doses to overcome the n/v associated her new tolerance. So she started taking them more often, got sicker, took them more often still to overcome the increasing n/v, until she called EMS. A beautiful, smart, intelligent 65ish y/o lady...yet this made perfect sense to her. I'm just saying... :wink: While that's working let's put her on O2 titrating SPO2 to mid-high 90s, and get the monitor set up and attached. Since she is at 98% already, we will put her on 6L NC unless someone objects. Your partner has set up the monitor and wants to know if you would like him to attach it to the patient. I agree that 2L is ok here as well...It's for psychological comfort at this point anyway. And yes, I'd like to attach the monitor. (everyone's a comedian) Thanks for the scenario doc! Dwayne Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 90 to 1 its toxicity i agree, but just in case.......... Orthostatic + or -?? Rhythm strip??? Stroke scale?? 12 lead??? 6L of o's??? your cause her to have a nosebleed by time you get her to the ED. 2 or 3 lpm sounds much better. Orthostatics are negative. Whatever stroke scale you are using this week is normal. You cut down her oxygen to 3 LPM. Your rhythm strip looks like this: So you get a 12-lead and this is what you see: Does anyone want to get a better history and perhaps touch the patient before we start running whatever testing we can think of. Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Any nausea or vomitting? Skin? Color (normal, pale, red, etc ), tenting, etc. Fever? Gas for heat/cooking? Does she have carbon monoxide detector? "You know, now that you mention it, I do feel a little nauseous, but I haven't thrown up." Skin exam is normal. Temp is 98.7 (you can make that rectal if you are so inclined). Electric stove. CO detector has not gone off (the batteries are working and FD has tested with negative results). Link to comment Share on other sites More sharing options...
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