ERDoc Posted December 17, 2007 Share Posted December 17, 2007 You are called to the residency of a 16y/o who is stating he can't breathe. The boys mother greets you at the door and tells you that for about the past 30 minutes he has been short of breath and it has been getting progressively worse. She tells you that he was at the doctors this morning for a sore throat and wasn't having any trouble breathing at that time. He has no medical problems or allergies. You walk into the living room and see an african american male sitting on the couch in obvious respitatory distress. RR 28, P 118, BP 108/72, Sat 83% Link to comment Share on other sites More sharing options...
Timmy Posted December 17, 2007 Share Posted December 17, 2007 Dangers? Grab a history and SAMPLE history. Eaten anything out of the ordinary? Hoping our GCS is 15? Is there anything visable around the throat like bruising, swelling or bite marks? What's our general apperance? Distressed, anxious? Are we speaking in sentences or short words? Breath Sounds, wheezing? Crackles? Cough? Can we take a deep breath or cough? Any pain when we do this? What’s our chest movement like? Skin colour/texture? Have a look in throat. Start 02 w/ nebulised salbutamol, maybe some adrenaline if were going with an upper airway obstruction. Maybe some sort of infection? Link to comment Share on other sites More sharing options...
Lone Star Posted December 17, 2007 Share Posted December 17, 2007 *stands back and watches Timmy work, ready to assist if needed* Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Dangers? Grab a history and SAMPLE history. Eaten anything out of the ordinary? Hoping our GCS is 15? Is there anything visable around the throat like bruising, swelling or bite marks? What's our general apperance? Distressed, anxious? Are we speaking in sentences or short words? Breath Sounds, wheezing? Crackles? Cough? Can we take a deep breath or cough? Any pain when we do this? What’s our chest movement like? Skin colour/texture? Have a look in throat. Start 02 w/ nebulised salbutamol, maybe some adrenaline if were going with an upper airway obstruction. Maybe some sort of infection? The kid states that he is having trouble breathing. He denies any chest pain. No history of neck trauma. He tells you he went to a doctor today and was told that he had an infection in one of his tonsils. He said that the infection was drained with a needle. He has not had anything unusual to eat. His GCS=15. There is no signs of trauma to his neck. When you look in his throat you can see a small puncture to the left tonsil with no drainage at this time. He appears distressed but not anxious. He has 3-4 word dyspnea. His lungs are clear bilat with equal air entry. He is able to take a deep breath without difficulty or pain. There is good chest movement. Skin looks cyanotic. You put him on high flow oxygen with no change in his symptoms and his pulse ox goes up to 85%. Link to comment Share on other sites More sharing options...
Timmy Posted December 17, 2007 Share Posted December 17, 2007 *Lets lone step in and take over* lol What about a fever? Difficulty lying flat? Voice muffled? Jess seems to think it’s Epiglottitis? Oh and if this is wrong you have specific instructions to direct hate mail to me lol Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 *Lets lone step in and take over* lol What about a fever? Difficulty lying flat? Voice muffled? Jess seems to think it’s Epiglottitis? Oh and if this is wrong you have specific instructions to direct hate mail to me lol No fever. He is able to lie flat with no change in his symptoms. His voice is not muffled. Link to comment Share on other sites More sharing options...
Timmy Posted December 17, 2007 Share Posted December 17, 2007 All I can think of is. Toxic episode from the aspiration or they’ve punctured something they shouldn’t have? Jess says sepsis? Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 All I can think of is. Toxic episode from the aspiration or they’ve punctured something they shouldn’t have? Jess says sepsis? What do you want to do for this kid? I will not confirm nor deny the diagnosis until others have had time to jump in. Link to comment Share on other sites More sharing options...
Lone Star Posted December 17, 2007 Share Posted December 17, 2007 Can the tonsil and adenoids actually become inflamed enough to obstruct the airway significantly enough to cause dyspnea? If so, what conditions are we seeing on visual inspection of the oropharynx? Any relief with the albuterol? Link to comment Share on other sites More sharing options...
Timmy Posted December 17, 2007 Share Posted December 17, 2007 What do you want to do for this kid?quote] Hmmm, hospital sounds like a nice place to go Link to comment Share on other sites More sharing options...
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