Just Plain Ruff Posted June 16, 2010 Share Posted June 16, 2010 (edited) This is a zebra scenario. This is also a NDA scenario. You are a hospital based ambulance service where you primarily work in the ED in the functions of a nurse (budget cuts you know) and you run ambulance calls on the side. Call volume about 350 calls a month. Your transports are around 30-60 minutes from scene to ER. You have a 3 hour trip to get to the next bigger hospital which is a 308 bed general medical facility. Your hospital is a 200 bed acute care facility and your ER volume is around 100 per day. There are smaller hospitals between you and the 308 bed facility. You have all the bells and whistles of a big hospital just a smaller package. Your lab is state of the art, they do everything and nothing hardly ever has to be sent out. Air transport is non-existent in your area. (you won't need them though unless you get this scenario wrong) You have a diverse population of people from all over the world. Many from Europe and many also from Africa. A 45-year-old woman calls 911 for bleeding gums and bruises on both forearms for the last 2 days. For the preceding 10 days she had been experiencing a high fever (which has since broken) and rigors. Edited June 16, 2010 by Ruffems Link to comment Share on other sites More sharing options...
Blue Goose Posted June 17, 2010 Share Posted June 17, 2010 Scurvy? Time of day, weather conditions, response time and ambulance staffing? Upon arrival: Type and condition of location? General appearance of the patient? Patient's posture? Skin condition? Vitals signs? Link to comment Share on other sites More sharing options...
Mateo_1387 Posted June 17, 2010 Share Posted June 17, 2010 What does NDA stand for? Link to comment Share on other sites More sharing options...
Kiwiology Posted June 17, 2010 Share Posted June 17, 2010 its probably ebola .... hope you like soup Link to comment Share on other sites More sharing options...
BushyFromOz Posted June 17, 2010 Share Posted June 17, 2010 its probably ebola .... hope you like soup Dammit, beat me... Link to comment Share on other sites More sharing options...
Kiwiology Posted June 17, 2010 Share Posted June 17, 2010 Dammit, beat me... Ew you trying to cop some of that sadistic man on man action arent you Link to comment Share on other sites More sharing options...
BushyFromOz Posted June 17, 2010 Share Posted June 17, 2010 Ew you trying to cop some of that sadistic man on man action arent you Nah, if i wanted to have sadistic man on man action, id say "Punch in the back of the head kiwi you man whore" or something to that effect......... Link to comment Share on other sites More sharing options...
DartmouthDave Posted June 17, 2010 Share Posted June 17, 2010 Hello, I would start by assessing the patient while my partner gets some vital signs (including a temp). What is this lady's general appearance? Skin colour? Jaundice? Frail? What is her enicity? Recent travel? Cheers Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted June 17, 2010 Author Share Posted June 17, 2010 (edited) Scurvy? Time of day, weather conditions, response time and ambulance staffing? Upon arrival: Type and condition of location? General appearance of the patient? Patient's posture? Skin condition? Vitals signs? type and condition of location: nice small well kept house. No clutter noted General appearance of patient: flushed face, worried in appearance. From the forearm down you see bruises and what appears to be a rash. Patients posture: straight backed in a chair Skin condition: blotchy in places that you can see. Looks like some mild bruising to what chest you can see that isn't covered with clothes. Eyes look exceptionally bloodshot Vitals BP: 98/40 P: 100 R: 20 O2sat: 98 Cap refill: >2 seconds but you are checking it on her hands Hello, I would start by assessing the patient while my partner gets some vital signs (including a temp). What is this lady's general appearance? Skin colour? Jaundice? Frail? What is her enicity? Recent travel? Cheers You got the vitals in an above post Her general appearance is well kept. Not frail She's Ugandan Recent travel: she went back to her homeland in Uganda 3 weeks ago. Edited June 17, 2010 by Ruffems Link to comment Share on other sites More sharing options...
DartmouthDave Posted June 18, 2010 Share Posted June 18, 2010 Hello, First, I think it is safe to say this lady is septic because of the history and the fact that she meets two of the Sepsis/SIRS criteria. A HR above 100 and a resp rate of 20. Now, a temperature would be nice. If not, is the skin hot? Cool? Also, her BP is low. More importantly, her DBP is only 40. As for the cause. Not sure. The petechia and the blood shot eyes are worrying. As for treatment. Lets get this lady in to the ambulance. Start an IV, a 500cc bolus to start. Do an EKG and get her in to a hospital gown. See anything new? Any photophobia? Stiff neck? Pain when she flexes her legs? Travel immunizations? N+V? Diarrhea? Cheers Link to comment Share on other sites More sharing options...
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