mobey Posted December 28, 2007 Share Posted December 28, 2007 This is my first scenario so bear with me!! OK this is a simple scenario based on an actual call I did. The pourpose is to take an accurate complete history, this will prove to be the only way to definitavely treat your patient. You work for an ALS service in a rural setting. You have a 1 hour transport time to the nearest hospital. You have all the treatments a normal ALS service does except 12 lead. It is july 2:00pm and you are called to a farmhouse at a horse ranch 10 mins out of town. Dipatch information: Respond to 22 y/o female, difficulty breathing. Caller states it is getting worse fast. You recognise the land location as being the ministers of the church. ALS will arrive at the same time as you. You arrive on scene to find a clean yard with lots of cattle, horses, chickens..etc. The house is fairly well kept considering there are 5 children in this family. You see your patient sitting against a wall in the kitchen, a first responder is holding an NRB on her face telling her to keep breathing. Your patient is in obvious distress, you can hear coughing, and choking from the porch. Her tidal volumes suck...seems everytime she tries to take a breath she chokes and coughs. Ok keep the questions to 2 or 3 per post, I hate it when 1 person asks every question there is and the scenario ends in 3 posts! Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 28, 2007 Share Posted December 28, 2007 ok the usual questions that are always asked Let's ask other not so obvious questions 1. Any history recent of bee sting or insect bite? 2. Chemical exposure 3. Was she doing anything strenuous prior to the onset like strenuous coughing or did she get hit by something to cause a pneumo? Link to comment Share on other sites More sharing options...
mobey Posted December 28, 2007 Author Share Posted December 28, 2007 ok the usual questions that are always asked Let's ask other not so obvious questions 1. Any history recent of bee sting or insect bite? 2. Chemical exposure 3. Was she doing anything strenuous prior to the onset like strenuous coughing or did she get hit by something to cause a pneumo? Family states she was out for a jog and came back sooner than expected because there were too many mosquitoes (multiple bites). You ask her about stings and she shakes her head no. Family states she came in, got in the shower, came out of the bathroom panting with shampoo still in her hair and told them to call an ambulance. No chemical exposure Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 28, 2007 Share Posted December 28, 2007 ok, multiple mosquito bites? How many? What are her lung sounds like? pqrst sample avpu pulse ox? Cardiac mon vitals? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 28, 2007 Share Posted December 28, 2007 oh I didn't read all the response I know you said no chemical exposure but....... Did someone just clean or recently cleaned the bathroom? Might they have used bleach and ammonia in the shower at that time? If so, might the water have activated the residual chemicals and she be having problems with that. Some people don't think that cleaning solutions are chemicals. just a thought. Link to comment Share on other sites More sharing options...
emt322632 Posted December 28, 2007 Share Posted December 28, 2007 Any urticaria? Does she feel like her throat is closing up? Agree with the chemicals in the shower. Also, was she cleaning recently? Is this the patient's primary residence or is she visiting? Could be a severe allergic reaction to the animals. On that note, has she taken care of or otherwise been in contact with the animals recently? Did this start before or after her jog? Lung sounds? Vitals. O2, IV, monitor... Link to comment Share on other sites More sharing options...
mobey Posted December 28, 2007 Author Share Posted December 28, 2007 Nope it's been a while since they cleaned the shower. I like that thinking though....Gotta admit I didn't ask that She shows you the mosquito bites on her chest (although she seems pretty hestant to do so...good catholic girl and all). They look like red welts, too big for mosquito bites. there are lots of them and she is scratching them. You check her back...yup more there. You think to yourself "Can a mosquito bite through a t-shirt and sports bra?" S Difficulty breathing, Red spots on chest and back, AE= Silent in bases wheezes in upper lobes, Stridor in upper airways. It is hard to assess because with every breath she gags and coughs. Puffy hands, lips, eyelids, etc. A Peniccilin M none P Pneumonia X 1 month ago L Lunch @ chinese restaurant at noon E Jogging PQRST See above.... SOB is rapidly progressing nothing the first responder did helped,(O2 that is). Pulse ox 90 Monitor = sinus tach Pulse 115 BP 100/70 Resp hard to assess around 50 very shallow Link to comment Share on other sites More sharing options...
mobey Posted December 28, 2007 Author Share Posted December 28, 2007 Any urticaria? Does she feel like her throat is closing up? Agree with the chemicals in the shower. Also, was she cleaning recently? Is this the patient's primary residence or is she visiting? Could be a severe allergic reaction to the animals. On that note, has she taken care of or otherwise been in contact with the animals recently? Did this start before or after her jog? Lung sounds? Vitals. O2, IV, monitor... Her family states she said it feels like she is swallowing "around something" she is not talking...Too busy trying to move air. This is her primary residence. She fed horses this morning at 9 like every other morning. This started while jogging. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 28, 2007 Share Posted December 28, 2007 ok What do the welts look like? Are they pustule like in appearance? If so I'm going to go down a very bad and serious road with this one. If they appear to just be welts then I'll be going down the road of allergic reaction and treat accordingly with IV benadryl, SQ EPI 1:1000 and high flow O2. Preparing for intubation is needed but we might be able to stave off a tube if we give her enough pharmacological interventions. Link to comment Share on other sites More sharing options...
emt322632 Posted December 28, 2007 Share Posted December 28, 2007 The way this is progressing leads me to believe it's an allergic reaction. Did she run through any vegetation while jogging? Poison ivy or poison oak comes to mind, maybe a severe reaction to something along those lines. I'd start treating for allergic reaction, epi 1:1000, benadryl, solumedrol. Let's see what that does. Link to comment Share on other sites More sharing options...
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