Feedback:Respiratory Distress Patient

[stcommodore]

PT: 79 year old caucasian male

Hx:MI, COPD, HTN, CHF

Arrived to find the male perpherial cyanosis, resp distress, pt stated abdominal pain and diarrhea. FD on scene had the patient on NRB 15 LPM.

Put him on the liter and to the ambulance.

EKG-couldn't get a good tracing, looked sinus.

12 Lead-no luck with that either

SP02 99% B/G 134. 20g IV Right Hand.

Only other substantial physical findings:some crackles (nothing dramatic) in right lower lobe

Total transport time 10min, on scene 7min. Doc said he suspected Pneumonia, was going with Bipap when I left. Thinking through treatments after the only thing I could have done different was throw in a neb.

thoughts? comments? suggestions?

[MSDeltaFlt]

Not enough information. Need VS, breath sounds (Rales? Rhonchi?), and quality of respirations. Tracheal tugging? Other assessory muscle use?

[stcommodore]

Breath Sounds:I heard maybe a crackle in the right middle lobe, but nothing drastic or dramatic enough to want to dictate treatment over.

Needless to say the next sick respiratory call I had that shift got CPAP, etc. Maybe saying we learn from our mistakes is to harsh but we take away something from every call and patient and build on it for the next.

[bryan20w]

Make sure you recognize that there is a major difference between bipap and cpap, bipap ventilates a patient where cpap just keep there airway open and will increase FRC.

[jwraider]

What about the HPI (history of present illness)

When did it start? If the MD thinks it was PNA there is probably more of a story behind this guy than he suddenly couldn't breath. I'm not sure what you're looking for feedback on how did you feel about your assessment? What questions did you ask to find out what was going on?

Thanks for the case presentation!

[explenture]

What about the HPI (history of present illness)

I'd like to know onset and at least skin temp.

Thanks for the case presentation!

[firedoc5]

Hx. of COPD and was on 15 lpm O2? How did he respond to the high flow O2? Pneumonia sounds right. Would need x-ray to confirm. Breathing treatment may not have helped in the field with that short of ETA to hospital.

[stcommodore]

For every person that says something about a fear of "hypoxic drive" in EMS there are then that says it shouldn't change your treatment. I got the "you have this copd'er on a nrb" face from the nurse but like I said he was in obvious distress and I had him for maybe 15min and not 2 hours.

[Leener77]

Exactly.....having a Pt w/ hx of COPD on high flow O2 for any type of difficulty breathing isn't gonna knock out their respiratory drive in the short amount of time we have them in the back of the ambulance......In most cases anyway, unless maybe you are on a long distance transfer......

[Ecnalubma08]

Hx. of COPD and was on 15 lpm O2? How did he respond to the high flow O2? Pneumonia sounds right. Would need x-ray to confirm. Breathing treatment may not have helped in the field with that short of ETA to hospital.

I was wondering about this too. I'm surprised the pts SPO2 was 99% being a COPDer.

It would be fun to look at some ABGs...hmmmm.