rocket Posted July 26, 2006 Share Posted July 26, 2006 PMHX, Meds, ALL, V/S's,complete head to toe assessment, and Events preceeding, v/s's including bilat B/P's pulse ox, 12-lead, and pert + and - cardio-respritory exam findings. Thanks, ACE844 What he said, most especially the bilat B/Ps (help to r/o AAA). The other DDx on my mind was appencitis so I'd like to ask about rebound tenderness just to get a better picture. She could be tachy/palpy from anxiety or it could be something more. Since I am on a BLS rig it's time to get packaged and moving...let's get her into a comfortable position (if possible) and do the vitals, PE and history. I'll defer on my option to call for ALS until I hear the vitals and findings of the exam. -Trevor Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 ok, when you isolate the kid from the parent, any further tox related information coem out? Is the pt a smoker? supplement user? Any signs of Drug abuse-use?What activities was she partaking in prior to coming home, running exertional, etc...? Next, since you didnt mention it, Breath sounds, what are the other B/P's, etc...? Any murmurs? Good catch I recall my last post. when you remove the pt. you get a better Hx. Cocain Last menstration was 10 weeks ago. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 What he said, most especially the bilat B/Ps (help to r/o AAA). The other DDx on my mind was appencitis so I'd like to ask about rebound tenderness just to get a better picture. She could be tachy/palpy from anxiety or it could be something more. Since I am on a BLS rig it's time to get packaged and moving...let's get her into a comfortable position (if possible) and do the vitals, PE and history. I'll defer on my option to call for ALS until I hear the vitals and findings of the exam. -Trevor no this became ALS a while ago, palpitations, HR -160, hypotensive... fallow Ace's lead. Link to comment Share on other sites More sharing options...
Ace844 Posted July 26, 2006 Share Posted July 26, 2006 Pt. denies using any drugs, or ingesting anything toxic. what does reciprocial mean? Reciprocal changes occur on a 12-lead in 'opposite' leads. So if there is elevation in a few leads, there will be depression in the 'opposite' leads. As far as the scene, i thought soemone had asked that, but in case not, add that to the list, and as well whatever other bystander, partmner, PD, etc.. info you can get or see. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Reciprocal changes occur on a 12-lead in 'opposite' leads. So if there is elevation in a few leads, there will be depression in the 'opposite' leads. As far as the scene, i thought soemone had asked that, but in case not, add that to the list, and as well whatever other bystander, partmner, PD, etc.. info you can get or see. Oh, watch your spelling, no just looks like ischemia.. probably do to the rythm. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 not to say I am a good speller I just didn't make out the word. Link to comment Share on other sites More sharing options...
rocket Posted July 26, 2006 Share Posted July 26, 2006 no this became ALS a while ago, palpitations, HR -160, hypotensive... fallow Ace's lead. Yup. With those numbers I'd agree. I'll be following along and learning now :wink: -Trevor Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Im on shift and have to go prepare dinner so I will be back in a few, start your Tx and I will get back. Link to comment Share on other sites More sharing options...
Ace844 Posted July 26, 2006 Share Posted July 26, 2006 OK, the short quick immediate answers are as follows...2+ large bore IV's, labs, 325 ASA PO {Barring contraindications} Low flow o2, as already started, a follow up 12-lead in a few minutes, and BENZO'S until anxiolysis-symptomtology reduction is achieved..extriacte to the ambulance and transport, as care is supportive mostly in this case. Link to comment Share on other sites More sharing options...
chbare Posted July 26, 2006 Share Posted July 26, 2006 Agree with ACE 844. I would consider a fluid challenge as long as the lungs are clear and there are no indications of heart failure. Nitroglycerin may be considered if we can maintain a stable systolic blood pressure. Lets see if the rate comes down with fluids. Stay away from beta blockers. Take care, chbare. Link to comment Share on other sites More sharing options...
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