Just Plain Ruff Posted October 15, 2007 Share Posted October 15, 2007 wellllllllllllllllllllllllllllllllllllllll ok what about bilat blood pressures? we are 15 minutes out - What are the vitals now? bp bilat pulse bilat resp rate pulse ox etco2 repeat 12 lead just for grins did you say if he took any meds? LIke digoxin? or some type of beta blocker or cardiac medication that he might have overdosed on? I know I'm missing something Link to comment Share on other sites More sharing options...
fiznat Posted October 15, 2007 Share Posted October 15, 2007 I'd like to hear about a few things from the physical assessment: -JVD? -Distal Edema? -Skin color/temperature/condition? -Any N/V? -Weakness? What kind of dishes was he washing? Could it be considered a strenuous activity for a person of his size/age/etc? Any additional stress at the time of onset? LBBB has the potential to create, as well as hide ST segment changes. If this person has a decent story and presentation (and it seems he does), I would not use the 12 lead as a rule-out for ACS since there is a LBBB. My suspicion is still high for AMI. Link to comment Share on other sites More sharing options...
chbare Posted October 15, 2007 Author Share Posted October 15, 2007 -Bilat pressures are within a few mm/hg. -Vital Signs B/P- 118/88, P-133, R-14 on a ventilator, Pulse oximetry-94% with Fio2 of 1, ETCO2-26, 12 lead is unchanged. -The patient does not take any known cardiovascular medications. -The patients peak pressures spike up to 38 and he requires frequent ETT suctioning. PIP's following suctioning range from 30-32. -A specific assessment technique may provide you with a clue that when combined with all of the other information will help solve this puzzle. Unfortunately, I suspect it is a technique that is often not covered in any depth. Take care, chbare. Link to comment Share on other sites More sharing options...
chbare Posted October 15, 2007 Author Share Posted October 15, 2007 - JVD is noted, no distal edema is noted, skin is pale and diaphoretic, no N/V. -The activity did not seem to be strenuous and no additional stressors are noted. -Hard to assess for weakness. The onset was quite sudden. You gather from you primary assessment that he has felt "like he has slowed down a bit" over the pat few months. Take care, chbare. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted October 15, 2007 Share Posted October 15, 2007 What is the patient's temp.? Could he have Staphylococcus or an Infective Endocarditis? Has he had any other symptoms relating to general illness, nausea, vomitting, etc? Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted October 15, 2007 Share Posted October 15, 2007 What about airway obstruction? Have we assessed for that? Did he tube easily or was there some resistance? Link to comment Share on other sites More sharing options...
p3medic Posted October 15, 2007 Share Posted October 15, 2007 whats his plateau pressures? Link to comment Share on other sites More sharing options...
ERDoc Posted October 15, 2007 Share Posted October 15, 2007 Which came first the trouble breathing or the pain in the chest? Did he have any chest pain in the prior few weeks? Any recent surgery, travel or immobilization? I don't remembered if you mentioned them, but what are the heart sounds? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 15, 2007 Share Posted October 15, 2007 I had a post all put together with the differentials of pulmonary edema and found similar to what doc was alluding to. does he have any history of trauma to the chest? Could he have pericardial tamponade or pericarditis that is really flaming? That could be a cause Link to comment Share on other sites More sharing options...
chbare Posted October 15, 2007 Author Share Posted October 15, 2007 -Ah..heart sounds! You appreciate the following: a high pitched systolic murmur is noted and you also note radiation of this sound into the axilla. For the sake of the scenario, you can assume this is a new development for this patient. -From what you gather, he had some tightness suddenly develop and dyspnea within several minutes of the chest tightness. No chest pain in the prior weeks, just the comment about slowing down in the past few months. -No surgery, trauma, immobilization, or chemical exposure. -Plateau pressures with a 20% inspiratory hold are running in the 30-34 range. -Temp is 98.9 F via rectal probe. -The intubation was performed without incident. Suctioning of airway secretions was required; however, no problems were encountered. Take care, chbare. Link to comment Share on other sites More sharing options...
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