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80y/o female vomiting


mobey

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Lets lean her forward so she can vomit into the floor and not obstruct her airway; if it's absolutely flowing out and she is obviously has an airway needing intervention then lets suction her airway.

Once the airway is taken care of, how is the rest of nana looking (re my above)

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It will be probably be easier to take it back than to look it up. Let me see if I can find it but I am cool and down with the gagging elderly lady.

Ahhh I see the singular pronoun there.

I thought I had a habit of letting down the other forum members here by starting a series of scenarios and then leaving.

I do believe I remember the one you are referencing, no need to look it up. Working remotely like I do, I often get 10-12 hour long calls in the middle of the night that screw up my brain for a day or two which is what happened that day.

Perhaps you did it with tongue in cheek humor... I really can't tell.

Is Nana one the infected peoples? Guess we gotta figure that out ;)

How long has she been vomiting? Hours? days? What's her history like? Any hepatic problems, ulcers, AAAs, diabetes, gallstones, abdo surgery etc? No history given. Last seen eating an hour ago.

What started it? Has she eaten anything different? Dunno! The meal was standard Wednesday lunch, nothing new

What have her symptoms been? What has she been vomiting up i.e. normal stomach contents, chunky bits or nasty, foul smelling malena? Normal stomach contents

During the time she has been vomiting has she been holding down fluids and if so, can we have a look at her fluid chart (if she has one) Staff says they did'nt know she was vomiting till they just found her and called you

How crook does Nana seem to be? Huh?

OK, leaning forward now

Snoring resps, deep at 20/min

Suction done.

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Ahhh I see the singular pronoun there.

I thought I had a habit of letting down the other forum members here by starting a series of scenarios and then leaving.

I do believe I remember the one you are referencing, no need to look it up. Working remotely like I do, I often get 10-12 hour long calls in the middle of the night that screw up my brain for a day or two which is what happened that day.

Perhaps you did it with tongue in cheek humor... I really can't tell.

Yea, no sweat. I did kinda jump the gun a little. So the lady has been suctioned. Why does the facility think they have a norovirus?

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Why does the facility think they have a norovirus?

There has been multiple care homes/long term facilities in the area with patients testing positive for Noroirus. When nearly a dozen people in this home develop coughs, and feers, the public health officer locks it down under the assumption the same here.

"Crook" means sick like how sick does Nana look

OK so leaning forward with deep snorous respirations; what is her conscious state like? Obs?

She in not responsive to verbal, but localizes pain..... just.

Her vomiting has stopped now. We strip her clothes off and get her onto the cot. What now? positioning? diagnostics?

I know this is a little basic for you adanced scenario responders, but maybe there is a nOob or two out there that could run us through a workup of an unknown unconcious?

As I said in the title... this is no brain buster.

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Ok, well let's do a blood glucose just for shits and giggles

Also do a stroke exam as well.

How bout checking her vitals

You know the basics

Since she's got some snoring resps, better protect that airway so maybe an oral airway for starters or nasal airway but if she pukes once again I'm gonna tube her becuase well darnit I can and because I'm a good person and a good medic. and because people like me. (I'm trying to build up my Intubation stats - they've been a bit low these past couple of months)

Edited by Captain Kickass
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Can we find out what sort of medical history this lady has/ what sort of meds she is on and whether she took them as indicated

Are there any medication bottles around the place and if so how empty (full) are they compared to what should be on the label

For right now the airway is my main concern; put in an LMA and see if that does the trick, however with that said, I have a strong preference towards RSI in this patient provided we can get it done without significantly extending the time it will take to get her to hospital; how far is the hospital anyway?

Do a quick physical exam to see if there's any obvious signs of why she'd have a lowered LOC e.g. big snake bite wound or something crazy like that

What are her obs/vital signs?

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Need to look for signs of dehydration, turgor, dry mucosal linings. LOC will be affected by dehydration. If this is the case fluids will help her mentation.

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While left lateral would normally be my preferred position, I'd like to sit her up in a high-ish Fowler's position for better assessment access.

If airway is clear, I'll attempt a head tilt, chin lift. Check for a gag reflex.

Tell me about her breathing: rate, rhythm, tidal volume, effort.

Based on that, I'll get her on oxygen via nasal cannula or BVM. Avoid a mask in case she vomits again. Additionally what are lung sounds.

Then after, we can move to circulation and all those history questions...

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While left lateral would normally be my preferred position, I'd like to sit her up in a high-ish Fowler's position for better assessment access.

If airway is clear, I'll attempt a head tilt, chin lift. Check for a gag reflex.

Tell me about her breathing: rate, rhythm, tidal volume, effort.

Based on that, I'll get her on oxygen via nasal cannula or BVM. Avoid a mask in case she vomits again. Additionally what are lung sounds.

OPA is attempted but the patient goes apniec, once it is pulled out, she starts to breathe again. No... not obstructed airway, I mean with OPA in place she does not attempt resperation at all. No gag reflex it appears.

With a NPA, and simple jaw thrust, the patient is taking deep resps at 22/min.

Her air entry is clear on the left, and rhonchi heard on the right throughout. No accessory muscle use.

Circulation: Pulses are exual at the radials, at a rate of 50bpm and strong.

Skin is warm at the core, cool extremeties. Skin turgor is usual for an 80 year old. Pink overall.

Now on the cot, the patient is responding to deep pain with only decorticate posuring.

History and meds are in previous post

Vitals: BP 130/90 HR50 RR22 Sp02 92% (room air)

EtCo2 (nasal sidestream) 20mmHg

BGL 5.1mmol

Here are your transport options

1) Local clinic with GP: 5min away

2) Primary stroke centre (utilizing mini CT and teleconference) 1hr away

3) Major hospital with surgery/ct etc 3hrs

4) Helo rendezous 45min away, then 30min flight to Major hospital.

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