shannon710 Posted January 10, 2008 Share Posted January 10, 2008 You are dispatched for difficulty breathing. 65 yo male trach pt at an ALF presents with SOB, decreased LOC and low o2 sats. Nurse states she found him supine in bed, semi fowlers position with sats in the 70's...what do ya wanna know? Link to comment Share on other sites More sharing options...
brock8024 Posted January 10, 2008 Share Posted January 10, 2008 is vent working and last time he was suctioned? Skin signs, vitals, meds, hx. Link to comment Share on other sites More sharing options...
shannon710 Posted January 10, 2008 Author Share Posted January 10, 2008 nurse suctioned about 45 minutes before this sudden onset. When you arrive on scene, initial vitals are BP 110/70 HR 130 Resp. 20 labored skin is pink from the chest line up, mottled from the waist down Patient's only known HX is diabetes. He is temporarily in the ALF for rehab of foot surgery 3 weeks ago. he had a reaction to anesthesia and had to be trached. Link to comment Share on other sites More sharing options...
Medic26 Posted January 10, 2008 Share Posted January 10, 2008 Fever? Complain of anything earlier in the day? Any new meds in last few days? Still on antibiotics? I am thinking maybe early sepsis but to early to tell. Link to comment Share on other sites More sharing options...
shannon710 Posted January 10, 2008 Author Share Posted January 10, 2008 no fever, skin is warm and dry. he complained to staff about feeling generally weak in the morning, but had still been able to ambulate to and from his wheel chair fine. nurse also states his fluid intake was alot more than normal. no longer on antibiotics and no new meds. Link to comment Share on other sites More sharing options...
brock8024 Posted January 10, 2008 Share Posted January 10, 2008 Lung sounds are??? I am thinking PE,Mucus plug, pneumonia, sepsis. I am leaning more towards the PE or mucus plug. He has been in bed for 3 weeks after surgery and probly not moving much. I would ask and see if he is on any blood thinning type meds. Pt with trachs that can not cough well or are dehydrated can get plugs deep in bronchials and have to come out. Link to comment Share on other sites More sharing options...
shannon710 Posted January 10, 2008 Author Share Posted January 10, 2008 lung sounds are clear, and i was leaning the same way, but there is something missing still. pt had been able to ambulate on his own, not bed ridden, and only in the wheel chair bc of surgery Link to comment Share on other sites More sharing options...
brock8024 Posted January 10, 2008 Share Posted January 10, 2008 12 lead or EKG. He could be ihaving a AMI. Link to comment Share on other sites More sharing options...
brock8024 Posted January 10, 2008 Share Posted January 10, 2008 What is his abd like. Is it soft or hard, tender or non???? Link to comment Share on other sites More sharing options...
shannon710 Posted January 10, 2008 Author Share Posted January 10, 2008 besides being tachy@ 160 now, EKG 12 lead unremarkable. head to toe reveals nothing, abd is soft non tender. **BTW BS is 464 mg/dl- tested by 2 different glucometers Link to comment Share on other sites More sharing options...
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