Dispatched to 16 y/o F Unknown

[scope2776]

Dispatched to 16 y/o F unknown CC at 0900. Dispatch advises that the address is for the local high school and PD is enroute. No further information.

You arrive at the school on a sunny day w/ no severe weather. The scene is safe. The principal meets you outside and instructs you to follow him. The school is fairly new, well kept, in the suburbs and serves mainly middle-class children from what you can tell. The principal leads you through the halls and past classrooms in session to a small first aid room next to the main office.

Your general impression is a 16 y/o F in respiratory distress. She doesn't appear traumatic and is well dressed.

The school nurse reports to you that this particular child had failed a final exam earlier this morning and has since complained of DIB. The "nurse" has the patient breathing into a brown paper sack, because she believes the child is suffering from "Hyperventilation Syndrome". She called 911 because this is the standard operating procedure for school emergencies.

The child is in one-word-dyspnea. You ask her whats wrong and she responds, "can't"..... "breath"....

What next? Complete the physical exam and treatments.

[speedygodzilla]

how bout some base line vitals?

Start the patient on 6lpm or 15lpm of o2 depending on the indication of stress.

[Bombera]

Well, the first thing that strikes me is that this girl is stressing out, but wisdom says to never assume a psychological cause without eliminated any physiological causes.

What are her vitals? A&O? Respirations? Pulse? BP? Skin signs? Pulse ox? Pupils?

Does she have any other signs and symptoms?

Is she allergic to anything? Are there any signs of an allergic reaction? Could be the first case of a school and test allergy.

Is she taking any medications? Does she have any kind of pertinent past medical history?

What was the last thing she ate?

Was there anything else that happened when the difficulty breathing started?

Does anything make it better or worse? How exactly does she describe how she's feeling besides not being able to breathe? Is it a crushing pain? Stabbing pain? Tightness?

Where is the feeling located and does it radiate anywhere?

On a scale of 1 to 10, how bad is it?

At what time did the difficulty breathing start?

Is she a smoker? Illicit drugs? Huffing?

Let's see if that narrows down the dx a little. :-)

Take care,

Bombera

[Dustdevil]

Minus 5 for using unapproved abbreviations.

DIB means "Dead In Bed" to me. Apparently you have made up something different, but I'm not sure what it is. :?

[spenac]

Minus 5 for using unapproved abbreviations.

DIB means "Dead In Bed" to me. Apparently you have made up something different, but I'm not sure what it is. :?

hahahaha. Scenario over call the funeral home.

[Just Plain Ruff]

Dust, I believe it might be Difficulty in Breathing. But I like to think of it as Dead in bathroom or dead in boat or dead in Ballpark

I think she had the following happen to her

Her mom yelled at her that morning, she failed not one but two tests, her bff jill is no longer her bff, and her boyfriend broke up with her.

I think she's just hyperventillating at some stressor and if we give her time she will calm down.

Did the paperbag help?

[Dustdevil]

Or at age 16 she has been smoking and taking OCs for five years already, and she just tossed a PE.

[Lone Star]

Minus 5 for using unapproved abbreviations.

DIB means "Dead In Bed" to me. Apparently you have made up something different, but I'm not sure what it is. :?

Minus 10 to Dust, DIB is a commonly approved abbreviation for 'Difficulty In Breathing'. In my 11 years, I've watched the acronym "SOB" (shortness of breath) fade as "DIB" took its place

[VentMedic]

DIB is a "slang" abbreviation adopted in the pre-hospital arena. DIB in the ER and hospital means Disability Insurance Benefits and is found on some of the ER admission paperwork as such. SOB has faded in some areas due to medical directors and managers not wanting the charting to look offensive if SOB is taken out of context. They would then make the pre-hospital personnel write it out. So, another shortcut was created that didn't sound offensive.

For medical charting it did not make the list of approved medical terms.

There is a billing code for difficulty breathing but no abbreviation.

DOE; dyspnea on exertion, more commonly accepted now for charting and testing criteria

SOB; still recognized for both medical charting and billing codes.

Lists of accepted abbreviations

http://www2.kumc.edu/pharmacy/medabbreviations.htm

http://www.stanfordhospital.com/PDF/SHCApp...dated051305.pdf

As for as the girl, if she has yet to be diagnosed with a reactive airway disorder such as asthma or other inflammatory process such as bronchitis ( or asthma), breathing into a paper bag will only enhance that with the dust particles. She may become quieter because her CO2 is rising also with increased retention by airtrapping and the bag re-breathing could push her to a dangerous level.

[jb135]

Give her O2 and take vitals. What do her lungs sound like? Also, ask the school nurse for her health sheet so you can get a history.