Jessi Posted August 23, 2008 Share Posted August 23, 2008 You are called to the home of a 23 y/o female with difficulty breathing. She lives with her mom who was freaking out upon your arrival. What do you want to do? Link to comment Share on other sites More sharing options...
fireflymedic Posted August 23, 2008 Share Posted August 23, 2008 Okay, first things first - mom's freaking out so let your partner get ahold of her and try to get information so you can get the girl calmed down. Second, determine whether she's in severe, moderate, or mild distress. With that determined, figure out if it's anxiety related or a physical problem. Does she have a hx of respiratory illnesses? Any trauma to the chest? Any chronic illnesses? After going from that get baseline vitals, including lung sounds, skin signs, o2 Sat, meds list, and go from there. Right now differentials include asthma, COPD, CHF, chronic bronchitis exacerbations, possible anxiety issues, allergic reaction, chest trauma, pulmonary embolus, and then with the info you give, I'll have a better idea of how to treat this young lady. Link to comment Share on other sites More sharing options...
SANDMEDIC Posted August 23, 2008 Share Posted August 23, 2008 Okay, first things first - mom's freaking out so let your partner get ahold of her and try to get information so you can get the girl calmed down. Second, determine whether she's in severe, moderate, or mild distress. With that determined, figure out if it's anxiety related or a physical problem. Does she have a hx of respiratory illnesses? Any trauma to the chest? Any chronic illnesses? After going from that get baseline vitals, including lung sounds, skin signs, o2 Sat, meds list, and go from there. Right now differentials include asthma, COPD, CHF, chronic bronchitis exacerbations, possible anxiety issues, allergic reaction, chest trauma, pulmonary embolus, and then with the info you give, I'll have a better idea of how to treat this young lady. ^Wow! yeah what he said. :shock: Link to comment Share on other sites More sharing options...
Jessi Posted August 23, 2008 Author Share Posted August 23, 2008 Okay, first things first - mom's freaking out so let your partner get ahold of her and try to get information so you can get the girl calmed down. Second, determine whether she's in severe, moderate, or mild distress. With that determined, figure out if it's anxiety related or a physical problem. Does she have a hx of respiratory illnesses? Any trauma to the chest? Any chronic illnesses? After going from that get baseline vitals, including lung sounds, skin signs, o2 Sat, meds list, and go from there. Right now differentials include asthma, COPD, CHF, chronic bronchitis exacerbations, possible anxiety issues, allergic reaction, chest trauma, pulmonary embolus, and then with the info you give, I'll have a better idea of how to treat this young lady. okay, so you get the mom under control. there is no history of any respiratory illnesses in either side of the family. no history of heart disease. no trauma is noted on the chest. mother said she had gone out to run a few errands and came back and saw her daughter sitting in the chair having a really hard time breathing. Vitals: BP- 116/70 P- 108 sinus tach Resp- 14, labored Breath Sounds- wheezing bilat. o2 sats- 94% RA Skin- pale, diaphoretic no medications, no history of chronic heart or lung disease, no history of anxiety attacks. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 23, 2008 Share Posted August 23, 2008 History of asthma or other breathing problems? Does she have a rescue inhaler? Chest pain or palpations? Lung sounds? Percuss chest. Diaphoretic, skin color and temp? Recent cold or flu? Does she smoke? And how much for how long? Anyone else in the house smoke (second hand smoke)? Numbness to extremities or around mouth, in case of hyperventilating from anxiety. Is she crying? Was there an argument or altercation between her and her mother? Or with anyone else that had left? Monitor. Low flow O2 per NC. Wouldn't worry about IV just yet. Set up for breathing treatment (Medical Control's choice on request). O2 sat before and after starting on O2. Link to comment Share on other sites More sharing options...
Jessi Posted August 23, 2008 Author Share Posted August 23, 2008 History of asthma or other breathing problems? Does she have a rescue inhaler? Chest pain or palpations? Lung sounds? Percuss chest. Diaphoretic, skin color and temp? Recent cold or flu? Does she smoke? And how much for how long? Anyone else in the house smoke (second hand smoke)? Numbness to extremities or around mouth, in case of hyperventilating from anxiety. Is she crying? Was there an argument or altercation between her and her mother? Or with anyone else that had left? Monitor. Low flow O2 per NC. Wouldn't worry about IV just yet. Set up for breathing treatment (Medical Control's choice on request). O2 sat before and after starting on O2. no smoking in the family. mother cant stand the stuff. no chronic lung diseases, no crying, no tingling in the hands or face. she seems "spaced out" and is very slow answering your questions. no arguments have taken place. the daughter was still asleep when the mother left to run errands. she left a note with the girl letting her know where she was in case something happen. when the mother returned home she found her daughter sitting in the chair having trouble breathing and called 9-1-1 her o2 sats are now down to 93%. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 23, 2008 Share Posted August 23, 2008 Is she leaning forward in the chair, orthropnea? Any new cleaning materials or even new carpet. We just had a gal at our church be admitted for formaldehyde poisoning from getting new carpet in their house. Did she have any breathing problems before going to bed or during the night? Was it sudden onset or gradual? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 23, 2008 Share Posted August 23, 2008 is she on birth control - I'd consider those nasty clots that Birth control pills have a tendency to throw. We can do everything in the ambulance we need to do so let's just get her goin. Link to comment Share on other sites More sharing options...
Chief1C Posted August 23, 2008 Share Posted August 23, 2008 Recreational drugs on board? Huffing some good old fashion aerosol contents? Type of heat in the home/CO detector? Smell of the room air? Musty, moldy? Lesions or bite marks, rash that is on her body that wasn't before she went to bed? Link to comment Share on other sites More sharing options...
Jessi Posted August 23, 2008 Author Share Posted August 23, 2008 She is sitting forward in the chair (tripod position) and you start noting accessory muscle use. she isnt on any birth control medicines. no new cleaning materials in the home and they don't have carpeting. only wood flooring which has been in place for several years. the house as a CO detector which is showing normal amounts of CO in the air. no new rashes, lesions, or bite marks. she denies any use of recreational drugs. other than a couple half empty bottles of advil, you don't notice any other drugs in the house. No difficulty breathing before she went to bed. As you load her onto the stretcher you notice she is very unsteady, she says her stomach is starting to hurt and she has a really bad headache and thinks she going to be sick. she doesnt really seem to be oriented to time or where she is at anymore and is starting to become agitated. You are enroute to the hospital which is 25 minutes away. What now? Link to comment Share on other sites More sharing options...
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