Rezq304 Posted June 25, 2007 Share Posted June 25, 2007 You are dispatched to a SNF for a 92yo female, unresponsive & breathing. Call received at 1800. Pt has been unresponsive since 1530. Link to comment Share on other sites More sharing options...
JakeEMTP Posted June 25, 2007 Share Posted June 25, 2007 Based on the information provided, the first thing I would do is a BGL check. I have come across this before at extended care facilities. ( sorry Itku2er ) . Link to comment Share on other sites More sharing options...
whit72 Posted June 25, 2007 Share Posted June 25, 2007 Two and a half hours of unresponsivness before the ambulance was called. Sweet. Vitals? Normal LOC? Diaphoretic? Link to comment Share on other sites More sharing options...
JakeEMTP Posted June 25, 2007 Share Posted June 25, 2007 Two and a half hours of unresponsivness before the ambulance was called. Sweet. Unfortunately Whit, I have seen this on numerous occasions. Apparently, the nursing home " provider " thought they were sleeping. :roll: Link to comment Share on other sites More sharing options...
MrSpykes Posted June 25, 2007 Share Posted June 25, 2007 Well Lets start with how unresponsive is she any rxn to a sternal rub? How is her breathing? rate? quality? Lung sounds? What are her skin conditions like? Grab a set of vitals(including pulse, BP, resp, Pulse-ox), start a line, get a sugar, put her on monitor. Look through the ECF's paper work looking at Hx, Meds, Allergies. See if there is any recent lab values on her. Link to comment Share on other sites More sharing options...
Rezq304 Posted June 26, 2007 Author Share Posted June 26, 2007 Pulse-62 BP-90/60 Resps-24 Lungs-Rhonchi noted at the bases, Wheezing in the upper Monitor-SR with (-) Ectopy or ST Changes BGL-21 (+) Diaphoreses Hx-CHF, COPD, Asthma NKDA Meds-Atenolol, Lisinopril, Albuterol, Atrovent (-) Response to painful stimuli What else? Link to comment Share on other sites More sharing options...
JakeEMTP Posted June 26, 2007 Share Posted June 26, 2007 I would try and sit this woman up and reassess lung sounds. Start an IV with NS and administer 50ml D50. Since you have already have a 12 lead, 15 lpm high flow O2, load pt. and take to the truck. Wait, does she have a DNR? Link to comment Share on other sites More sharing options...
MedicRN Posted June 26, 2007 Share Posted June 26, 2007 BGL-21 Is this ml/dl? If so, 12.5-25gm D50 and see what that does. Wait, does she have a DNR? What does DNR have to do with it? She's not in cardiac arrest.......... yet. Link to comment Share on other sites More sharing options...
AZCEP Posted June 26, 2007 Share Posted June 26, 2007 A full 25 grams of D50 might be a bit of overkill. With the age and friability of her veins, 50 mL of D10 might be a better option. It's not as hypertonic, and won't do as much damage to the veins. DNR status might be useful, but this patient still needs treated. Now how about someone find out why her BGL is so low? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted June 26, 2007 Share Posted June 26, 2007 if she's on insulin, how much did they give her last? I can just imagine a LPN or (*gasp*) a Nurse gave her too much insulin. Link to comment Share on other sites More sharing options...
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