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S/P Hemodialysis Dyspnea


BVESBC

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I spoke to the hemo monkeys about a hour ago the pt expired no other info. I really wanted to know what they found, oh well i guess that's the way it goes sometimes. Everyone brought up some interesting ideas on this one, I'm leaning towards a multi system event here.

Asysin2leads,

My only true interest in the possibility of asthma was the sudden onset w/ cold air, you are right, lungs CTA all fields rules that out. What are the chances of a pt having a cardiac event w/o atypical presentation CP radiating, diaphoresis, and only dyspnea as a symptom? I had not really considered cardiac as she was not typical cardiac presentation. (tunnel vision on my part towards Respiratory) Maybe I'm over analyzing this, there is obviously nothing I could have done at the BLS level that I didn't do.

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L & S saved us about 10 min in this urban mecca of non driving morons! Yes one block!

Uh huh.

As for remembering all of the DX, RX, Alg, it is a perdiem job in three years I MIGHT have seen this pt once before.

I never said you did or could.

I don't think that any providers memory should be substituted for a proper pt transfer of care.

I never said that I did, could, or should.

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What are the chances of a pt having a cardiac event w/o atypical presentation CP radiating, diaphoresis, and only dyspnea as a symptom? I had not really considered cardiac as she was not typical cardiac presentation. (tunnel vision on my part towards Respiratory) Maybe I'm over analyzing this, there is obviously nothing I could have done at the BLS level that I didn't do.

I'll rephrase your question a bit. The chances of someone having a "typical" cardiac event presentation are extremely low, and those chances get even lower when you throw in diabetes. Many times the only signs of a cardiac event is difficulty breathing, or the sensation thereof, in the absence of another obvious cause, i.e. asthma or COPD.

You are right that the lack of diaphoresis is a bit odd for someone having an acute cardiac event. However, I'm willing to bet a shot of Jameson that if you go back and look at your patient, they were on a beta blocker such as metoprolol, which many times masks the adrenergic presentations of acute patients.

All in all it sounds like you did this call pretty well given what you know and have to work with at the BLS level. My advice would be, consider every diabetic who is complaining of difficulty breathing as having a heart attack until proven otherwise.

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I had one presenting only with abdominal pain WITH a history of ulcers, AND the first 12 lead came back clean. It was only when I did a second that the ST elevations showed up. Score one for beating a dead horse.

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Enjoying this thread immensely, makes me want to go and review CRF!

It seems like with this patient there was very little that could be done at the BLS level. If I had been on an ALS truck, everything Asys said: 12 lead, IV, O2.

Seems like you handled the call very well.

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I've mentioned it before but I had a patient with non-stop hiccups.

You guessed it active MI. No other S/S. Just hiccups.

I was at an EMS continuing ed class with an electrophysiology attending just last week. He gave that exact presentation as the result of a pacemaker wire breaking loose and perforating the diaphragm. So the diaphragm itself was being paced, which caused the hiccups.

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Feb 16th 08 I was taken by ambulance to the hospital with IV and oxygen, because my sats were in the 70's. I was fighting every night to get comfortable and trying to breathe, sleeping was the pits, I know I was dehydrated. I started with a cough that got worse and sleeping flat was not the answer. I started to take my asthma meds, didnt help.

Friday I get to the hospital and I sat in a wheelchair with oxygen from 6:30pm till 12:45am and at that time I got a reclining chair, because all the beds were taken because of the superbug that hit Calgary.

I was in the ED from 12:45am til noon and finally got a bed, was in hospital for a good week, they told me if I left it any longer I would be in intensive care or better yet, dead.

So where she was coming from, not being able to breathe, I forgot a lot of things to tell the medics to, but of course I couldnt talk to well at all either.

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