ERDoc Posted February 19, 2006 Share Posted February 19, 2006 A 59 y/o woman with a history of lung ca with mets to the brain calls you because of a near syncopal episode. One week ago she was admitted to the hospital for 2 days secondary to a syncopal episode. For the last two days she has not been feeling well, has had a few episodes of vomitting and some diarrhea. She is not complaining of any pain at the moment. Her VS are: 118 86/77 18 97% on RA. What else do you want to know and what do you want to do for her? Link to comment Share on other sites More sharing options...
AZCEP Posted February 19, 2006 Share Posted February 19, 2006 DNR status Depending on that: O2, probably a little for now IV, she sounds a bit dehydrated ECG last oral intake, and her current meds That is a good place to start. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted February 19, 2006 Share Posted February 19, 2006 With all that above and if she is getting any palliative therapy such as chemo or radiation tx. Chemo tends to dehydrate as well.. Last time how the platelet count was, if she does have tx.'s Is there any associated fever? See if she is taking any analgesics such Oxycontin, fentyl patch etc.. and last time she had any. Be safe, R/R 911 Link to comment Share on other sites More sharing options...
Guest Posted February 19, 2006 Share Posted February 19, 2006 I agree, I would treat her for dehydration due to the nausia and vomiting, low B/P, ect. Palative care as needed. Have the DNR in case she codes. ..... would treat current problems whether DNR or not..... Link to comment Share on other sites More sharing options...
ERDoc Posted February 19, 2006 Author Share Posted February 19, 2006 She is full code. Last chemo was 3 weeks ago, no radiation yet. Labs were normal when she was d/c last week. The only access you are able to get is a 22 in the back of the right arm. Fluids are going and after 2L her pressure is 90/80 with a HR of 140s (STach). You put her supine and she is now complaining of some very mild pain in the epigastric area going to her back and lower chest. She also gets that gray look to her face (the more seasoned know that gray around the gills, I'm going to die soon look). She is still conscious, but more somnolent. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted February 20, 2006 Share Posted February 20, 2006 Got Priest ? ............. Hmm... Sounds like an omnious triple A .. of with other things.. mets might have went systemic into arteral walls.. notify the Doc.. go ahead with some fluid and monitor the pressure..If it is a AAA, want to keep her pressure down. Hopefully, you can get a larger line after some fluids, but you take what you can get at times. Expedite since she is a full code, I really would prefer not to be working on her if she does arrest with term. Ca... Good scenario as usual Doc! R/R 911 Link to comment Share on other sites More sharing options...
ERDoc Posted February 20, 2006 Author Share Posted February 20, 2006 Got Priest ? ............. Hmm... Sounds like an omnious triple A .. of with other things.. mets might have went systemic into arteral walls.. notify the Doc.. go ahead with some fluid and monitor the pressure..If it is a AAA, want to keep her pressure down. Hopefully, you can get a larger line after some fluids, but you take what you can get at times. Expedite since she is a full code, I really would prefer not to be working on her if she does arrest with term. Ca... Good scenario as usual Doc! R/R 911 Abd is soft, not distended, nontender. Your state of the art dept has an ultrasound machine and you look at the aorta and it looks normal. You cannot find anything in the arms or legs, but the EJs are like pipes and you have no problem dropping in an 18. You give her 2 more liters and the pressure stays the same. What else are you thinking? Link to comment Share on other sites More sharing options...
MrSpykes Posted February 20, 2006 Share Posted February 20, 2006 Is she on any diuretics? Does she have a fever or anything. What are her lung sounds like. I am thinking maybe cardiogenic or septic shock. Does she have a history of HTN. Could be an arotic dissection. Patrick Indiana EMT-B Paramedic Student Link to comment Share on other sites More sharing options...
ERDoc Posted February 20, 2006 Author Share Posted February 20, 2006 Is she on any diuretics? Does she have a fever or anything. What are her lung sounds like. I am thinking maybe cardiogenic or septic shock. Patrick Indiana EMT-B Paramedic Student No diuretics. Afebrile. Lungs are clear. Link to comment Share on other sites More sharing options...
TechMedic05 Posted February 20, 2006 Share Posted February 20, 2006 12 lead? Just for good measure, and and edema present? Possibility of an Inferior MI, or just R sided failure secondary to the Lung CA. Link to comment Share on other sites More sharing options...
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