itku2er Posted July 23, 2008 Share Posted July 23, 2008 You are called to a SNF for a SOB call. You arrive to find a 68 yo female sitting in a chair using accessary muscles to breath. Her nail beds are blue toe nail beds blue no pedal pulses as reported to you by the nurse. Skin is warm and dry face pale legs mottling. Her clothes are wet due the sweating she has done prior to your arrival. VS Temp:98 pulse:130 bounding Resp:32 BP:140/78 O2: 81% on 5 l n/c Link to comment Share on other sites More sharing options...
brock8024 Posted July 23, 2008 Share Posted July 23, 2008 1) Exacerbation of COPD 2) Exacerbation of CHF 3) AMI 4) PE Link to comment Share on other sites More sharing options...
brock8024 Posted July 23, 2008 Share Posted July 23, 2008 What pt hx? Lung Sounds? Link to comment Share on other sites More sharing options...
itku2er Posted July 23, 2008 Author Share Posted July 23, 2008 Good choices brock and one of them is correct Link to comment Share on other sites More sharing options...
itku2er Posted July 23, 2008 Author Share Posted July 23, 2008 What pt hx? Lung Sounds? HX: Hip surgery 2 weeks ago AFIB H/O MI 2 years ago with 3 stents placed BBS: very little air exchange heard Link to comment Share on other sites More sharing options...
brock8024 Posted July 23, 2008 Share Posted July 23, 2008 What her meds? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 23, 2008 Share Posted July 23, 2008 HX: Hip surgery 2 weeks ago AFIB H/O MI 2 years ago with 3 stents placed BBS: very little air exchange heard based on the above history == hip surg 2 weeks ago, afib and stents I'd go with PE Link to comment Share on other sites More sharing options...
itku2er Posted July 23, 2008 Author Share Posted July 23, 2008 Dig Coreg Vit C Multi vit Lasix lortab for pain Ativan for anxiety Priolsec Reglan Zocor lopressor librium Link to comment Share on other sites More sharing options...
spenac Posted July 23, 2008 Share Posted July 23, 2008 Was there a male in her room just prior to nursing home finding her? Nursing home sex is getting to be big problem. O2 @15LPM immediately by non rebreather. Can she talk at all? Is she alert and oriented to her normal? 12 lead? Large bore IV X2 if possible Confirm pulses or lack of as I trust no one especially nurses :twisted: . Does nursing home have history of meds and health problems immediately available. Any pulsation at abd? Need to be taking care of everything on the go if it is what I suspect. She is FTD. Link to comment Share on other sites More sharing options...
brock8024 Posted July 23, 2008 Share Posted July 23, 2008 She has a PE. Link to comment Share on other sites More sharing options...
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