EMS_Cadet Posted June 15, 2007 Share Posted June 15, 2007 You are dispatched to a respiratory distress for a 82 year old female. You arrive at a assisted living facility. A family member greets you at the door and directs you to the patient's apartment. Upon arrival to the patient's apartment, you see a elderly looking female appearing to have some slight respiratory distress. She is on home oxygen and you notice some MDI's on the table next to the patient. Hx: COPD, IDDM, HTN. Meds: Insulin, HCTZ, Benazepril, Ecotrin, and the MDI's for the COPD. Vitals: 140/90. Pulse @ 92 and regular. Resps @ 24 and slightly labored. Skin is slightly diaphoretic, but otherwise pink and warm. Temp is normal. EKG: NSR with no ectopy. What else do you want? What do you think is going on right now? Link to comment Share on other sites More sharing options...
mobey Posted June 15, 2007 Share Posted June 15, 2007 Onset (time, sudden/slow onset)? SPO2? Associated symptoms? (chest pain) Has this happened before? BGL? Has she taken her MDI for this event? Are the MDI's empty or expired? Air entry sounds? Smoker? Is home O2 on and working to cannula? K thats enough for now! Link to comment Share on other sites More sharing options...
cosgrojo Posted June 20, 2007 Share Posted June 20, 2007 This is BLS. Pt's probably having COPD exacerbation. Priority 3 transport to hospital. Get all the things previously mentioned and constantly assess lung sounds. Keep pt on O2. Most likely pt will be in same condition on arrival at ER. If things change, up the O2 and prepare yourself to call medics in if you are BLS. If you are ALS, Nebulizer in accordance to your local protocols. You probably would have already established a line because ALS loves needles. Simple call... as always prepare for the worst. This is the type of pt that if it goes bad, there is very little you could have done to prevent it, so you are just going to have to roll with it if you have to. Link to comment Share on other sites More sharing options...
ERDoc Posted June 21, 2007 Share Posted June 21, 2007 Simple call... Sure about that? Want to hang your hat on that without a physical exam or EKG? I think we need a lot more info. DDx at this time includes COPD, MI, PE, CHF, pneumonia, pericardial effusion/tamponade, dissection just to name a few. Link to comment Share on other sites More sharing options...
WendyT Posted June 21, 2007 Share Posted June 21, 2007 She's probably on to much 02 that could be her reason for not able to catch her breath, second of all she could of been in an area of someone wearing perfume and that is an area I came across a man in the mall and I said to him are you ok, because you could hear him wheezing and coughing hard, even though she wasn't coughing at all. Food allergy, pneumonia, irritants, anxiety. Blood pressure on a person with anxiety can also be normal and can also fluctuate Link to comment Share on other sites More sharing options...
ericenglund Posted June 21, 2007 Share Posted June 21, 2007 Allergies? Did she chill at home today or go somewhere new and possibly expose herself to something? BGL / last time she took insulin/last time she ate? 12-lead? Sp02? any recent surgeries, does she smoke? lung sounds? have her describe how everything else, throat, head, chest, abdomen..yadayadayada, feels. like doc said "COPD, MI, PE, CHF, pneumonia" are all possible DDx, maybe DKA? Link to comment Share on other sites More sharing options...
EMS_Cadet Posted June 23, 2007 Author Share Posted June 23, 2007 Onset (time, sudden/slow onset)? SPO2? Associated symptoms? (chest pain) Has this happened before? BGL? Has she taken her MDI for this event? Are the MDI's empty or expired? Air entry sounds? Smoker? Is home O2 on and working to cannula? K thats enough for now! SpO2: 92% on 2LPM via NC (home oxygen therapy). Onset: The patient was eating, got done, and decided to watch some TV. The dyspnea started while watching TV. Associated symptoms: Weakness, upset stomach. Has this happened before: "Not really, I just can't catch my breath." BGL: 102mg/dl. MDI: Positive use...Three albuterol treatments...No relief. Breath Sounds: Superior - Slight wheezing. Inferior - Rhales. Smoker: Used to be, not no longer. Everything is good with the home o2. Link to comment Share on other sites More sharing options...
Quicksilver Posted June 23, 2007 Share Posted June 23, 2007 How is she sitting, upright, lots of pillows, any different then how she was sitting when the DIB started? :arrow: Link to comment Share on other sites More sharing options...
Inf Posted June 23, 2007 Share Posted June 23, 2007 Pedal edema? JVD? Finger clubbing? Birth control use? could be cardiac asthma, PE, APE, STEMI, NSTEMI, unstable angina... have you done a 12 lead? Link to comment Share on other sites More sharing options...
nick46928 Posted June 23, 2007 Share Posted June 23, 2007 Pedal edema? JVD? Finger clubbing? Birth control use? Birth control? She is 82yo. I seriously doubt she is on birth control. Link to comment Share on other sites More sharing options...
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