Have you ever had a drug seeker present with pulmonary edema

[brock8024]

Well I am shocked but not. I was hoping this would go somewhere. It would have been interesting. OH well. I kind expected it.

[DwayneEMTP]

Second Who cares is she is a drug seeker?

So you are not going to answer our questions or anything. Just thanks I got what I needed???

You made it clear you didn't care about the part of the scenario she found interesting, even though chbare, one of the smartest people on the City, thought it was relevant. And then have the gnads to be offended she didn't answer your other questions?

You got the response you deserved.

She is in trouble at the moment and needs help.

...no accessory muscle use, skin pink and warm, vitals normal, O2 sat at 100%

You know, I'm just a dumb ol' medic student...but I'm trying to see what criteria you've used to decide this patient is in big trouble? Does it sound like she's having an issue...sure. Is it time to throw the entire hospital at her...I don't see it.

So she could be in acute pulmonary edema, pneumonia, or be having a AMI. If I remember right AMI affecting the left ventricle could cause acute pulmonary edema? If I am wrong please correct me. I am not perfect and always willing to learn.

She could have bronchitis, have aspirated her jello, been gargling with salt water...We don't really know yet do we?

She is in her 40's? Is she overweight? Any hx of chest pain or having this before. She said no to the bipap and c-pap fast, so has she ever had one on before or did you explain what it was to her. She is tolerating a NRB mask but not c-pap or bipap mask?

Yeah, seems pretty hinky doesn't it.

Lighten up man...Ask good questions with some respect and you'll get good answers. I know...I've asked her a million of them...

Did you get lung sounds on this woman Kaisu? Is it possible you were hearing rhonchi instead of rales?

Cool case...I'd like to hear more about her presentation...We can PM if you'd prefer to avoid all of the bitching in this thread....

Dwayne

[Kaisu]

Dwayne.. you most totally and completely rock man... I too am a dumb medic student and the reason this case interested me is the lady sounded exactly like a guy I had picked up a couple of weeks earlier who was too obtunded for CPAP - and the discrepancy between the way she sounded and the way she looked I could not explain.

It's a sad case in that the woman is definately a drug seeker, but her abuse of narcotics has now given her a very real problem.. I was in basic class with her husband, who is a very cool guy but when I started to talk to him about her drug issues, it was like mental blinders came down over his eyes and a very smart, articulate and funny man all of a sudden became purposely obtuse.

I can't answer the specific questions about her because she was not my patient and I notified the appropriate people and left it at that. (I had alligators snapping at my ankles that I had to attend to).

Next clinical shift, I will try and find out more and I will post it here because you say you are interested. Please wait for it and I will get it for you.

[Jess]

Excellent post! However, I'd like to hear more about the case if you have more info. I'm learning hungry right now! I have actually considered doing some ER clinicals to keep up on my skills! But excellent posts kaisu and Dwayne!

[brock8024]

You made it clear you didn't care about the part of the scenario she found interesting, even though chbare, one of the smartest people on the City, thought it was relevant. And then have the gnads to be offended she didn't answer your other questions?

You got the response you deserved.

Did I say that the drugs where not relevant? She said drug seeker and stated pt's hx of drug abuse. Never said why she was in the ER. that is what I was confused about. I am not trying to play who is smarter. I know that drugs can cause ARDS so I am not saying it is not the drugs was just trying to figure out why she was in ER.

You know, I'm just a dumb ol' medic student...but I'm trying to see what criteria you've used to decide this patient is in big trouble? Does it sound like she's having an issue...sure. Is it time to throw the entire hospital at her...I don't see it.

Did I ever say throw the whole hospital at her? I do not think so. I mentioned some test that needed to be done that is all. Can someone be compensate and have normal vital and skin signs but be about to crash? She had to think the pt was in trouble since she heard wet lung sounds and said she may need bipap. That tells me that she is having some type of trouble. I never said BIG trouble just plain trouble. Meaning she could go down fast or she may not. Definitely need to get on it though.

She could have bronchitis, have aspirated her jello, been gargling with salt water...We don't really know yet do we?

You are right, but I was saying the different things that could be wrong with her at the time that could be life threating. She had a bronchoscope within a month. Why did she have that?? That is a red flag for me.

Yeah, seems pretty hinky doesn't it.

Lighten up man...Ask good questions with some respect and you'll get good answers. I know...I've asked her a million of them...

Well I think I did ask good questions. If I seem disrespectful it was because we did ask and never got a answer.

Did you get lung sounds on this woman Kaisu? Is it possible you were hearing rhonchi instead of rales?

Cool case...I'd like to hear more about her presentation...We can PM if you'd prefer to avoid all of the bitching in this thread....

Dwayne

When was I bitching???I just was wondering why she did not answer anymore questions that was all.

[brock8024]

No one ever said anything about anyone being a dumb medic student. We was all there at one time or another. I had no idea that you just went in told the nurses and then left. I do not see why people get so offended when we ask questions. I never said anyone was dumb or anything. I was just giving different problems it could be and that was all.

It bothers me that students get offend and feel like they are being attacked. I never had that intent. I do feel like I was attacked for just asking questions.

[chbare]

"...even though chbare, one of the smartest people on the City, thought it was relevant."

Thank you, I have a few lucid moments here and there; however, most of it related to my mad ninja Google and E-medicine skillz.

Obviously, we have many problems to rule out with this patient. I simply answered the question asked by the OP. Narcotic induced pulmonary edema is not a common problem, and it is seen more often in herion users, so, there are many other problems that need to be considered as well.

Take care,

chbare.

[brock8024]

"...even though chbare, one of the smartest people on the City, thought it was relevant."

Thank you, I have a few lucid moments here and there; however, most of it related to my mad ninja Google and E-medicine skillz.

Obviously, we have many problems to rule out with this patient. I simply answered the question asked by the OP. Narcotic induced pulmonary edema is not a common problem, and it is seen more often in herion users, so, there are many other problems that need to be considered as well.

Take care,

chbare.

I agree with you here. ARDS is what I was thinking and is typically non cardiac pulmonary edema. And the drugs most commonly that cause this are the ones that chbare said.

[chbare]

Of course, without additional information, we cannot rule out narcotic induced pulmonary edema. I guess we are all in the same boat waiting for the follow up.

Take care,

chbare.

[brock8024]

Of course, without additional information, we cannot rule out narcotic induced pulmonary edema. I guess we are all in the same boat waiting for the follow up.

Take care,

chbare.

Was the drugs a important thing or not. With the hx of the bronch done with in the last month it was a flag to me. That is where I was coming from. I agree chbare that without more you can not really rule that it was anything.

I had to do a 30 min presentation on ARDS and I remember talking about drug induced ARDS.