P_Instructor Posted July 14, 2011 Share Posted July 14, 2011 What is the size of your patient (ie. weight, frail, thin, etc...) All things need to be looked at and everyone has good ideas. Any history of prior lung problems that may indicate a small spontaneous pneumo that cannot be detected with lung auscultation??? Just wondering... Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 14, 2011 Author Share Posted July 14, 2011 What is the size of your patient (ie. weight, frail, thin, etc...) All things need to be looked at and everyone has good ideas. Any history of prior lung problems that may indicate a small spontaneous pneumo that cannot be detected with lung auscultation??? Just wondering... Small geriatric female. I would not call her thin or frail. No previous respiratory problems just the mitral valve replacement, hypertension, and diabetes. What would your treatment plan and DDx be? Link to comment Share on other sites More sharing options...
Bieber Posted July 14, 2011 Share Posted July 14, 2011 I didn't know that, interesting. You have administered the nitro. Yes the lung sounds were clear and remain clear. You have a line in place. Her BP is now 124/86 HR- 120 RR 24 still labored SpO2- 98 serial 12 leads still show no ectopy. I like your DDx. Are you en route to the hospital yet? Yes, I'm en route now. Let's go to the nearest appropriate facility (cath lab minimum, preferably with the ability to do a CABG as well). How is the patient's pain now? Are we having any change at all in the severity or quality of the pain? Let's give a nitrotab every five minutes, and go ahead with 1 mcg/kg of fentanyl if the patient's still having pain after x3 nitro as long as we maintain a pressure >100 systolic. P_Instructor, if the patient is having a pneumothorax small enough to remain undetected, do you think it would still be enough to cause the patient this much distress? I haven't yet encountered a pneumothorax of any kind, but I would think it'd have to be fairly large to cause so much discomfort. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 14, 2011 Share Posted July 14, 2011 You gained no relief in respiratory distress, gained 20 bpm in pulse rate, have no report as to its effect on pain, yet you want to continue that treatment assuming only that the bp stays above 90 systolic? You sure? Dwayne Link to comment Share on other sites More sharing options...
Bieber Posted July 14, 2011 Share Posted July 14, 2011 Hm, I think you're right, Dwayne, I was a little hasty there. Let's reassess first, and increase that O2 to 15 LPM by NRB if we haven't already. 1 Link to comment Share on other sites More sharing options...
DartmouthDave Posted July 14, 2011 Share Posted July 14, 2011 Hello, Nice scenario FireEMT2009. Difficult to describe and define chest pain in a diabetic women with dyspnea. Stable VS currently. Things to add: 1) Check BP in both arms and quality of pulses 2) Any history of illness in recent history? Treatment: 1) Supportive care and transport as noted above. My DDx list: 1) MI 2) Thorasic Anerysum 3) PE (small) 4) MSK pain I am sure I could come up with a few more. But, I am blanking right now. Cheers Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 16, 2011 Author Share Posted July 16, 2011 Hm, I think you're right, Dwayne, I was a little hasty there. Let's reassess first, and increase that O2 to 15 LPM by NRB if we haven't already. You have it on and you are now 4 minutes away from the hospital. You already have an IV establised. Vitals are still the same as the above. Patient is still having shortness of breath but has gotten a "tad" better with the oxygen. Nothing else is making it better or worse. Hello, Nice scenario FireEMT2009. Difficult to describe and define chest pain in a diabetic women with dyspnea. Stable VS currently. Things to add: 1) Check BP in both arms and quality of pulses 2) Any history of illness in recent history? Treatment: 1) Supportive care and transport as noted above. My DDx list: 1) MI 2) Thorasic Anerysum 3) PE (small) 4) MSK pain I am sure I could come up with a few more. But, I am blanking right now. Cheers Thank you Dave. No recent history of illness just the mitral valve replacement and the diabetes. I have found your treatment plan interesting considering that it it is justi giving the basic V.O.M.I.T. acroynym to good use. You already have an IV established. Is MSK pain muscloskeletal pain? If so the pain cannot be reproduced on palpation over the chest. Sorry it took me so long to reply and give ya'll updates I have been busy the last couple of days and I apologize. FireEMT2009 Link to comment Share on other sites More sharing options...
BushyFromOz Posted July 16, 2011 Share Posted July 16, 2011 Does the pain increase or decrease when she leans foreward? Ive seen this before, some bloke tore himself a new hiatial hernia getting out of a chair, the SOB was diaphragm rigidity from the inflammatory response. Link to comment Share on other sites More sharing options...
DartmouthDave Posted July 16, 2011 Share Posted July 16, 2011 Hello, V.O.M.I.T. acroynym? I have never heard of it. Cheers Link to comment Share on other sites More sharing options...
usmc_chris Posted July 16, 2011 Share Posted July 16, 2011 Hello, V.O.M.I.T. acroynym? I have never heard of it. Cheers Vitals Oxygen Monitor I.V. Transport Link to comment Share on other sites More sharing options...
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