First job, Central Station!!!!!
But this pt alerted their situation to the transit staff and therefore we got straight to them.
Young person with abdo pain.
Lower right, radiates to centre, some rebound tenderness, sounds like a possible appendix to me.
Mid Forties fella, eights days post spinal fusion, living rough with back pain.
Gave the most opiate that I have ever given so far and I was only just making a dent in the pain.
I could have given the same again and not maxed out for his weight but I have to walk fast before I run as I become more comfortable with larger drug doses.
And that was it three jobs again,
Until half hour before end of shift.
Respiratory Distress, 60 y/o pt, no asthma diagnosis but has puffers, bronchitis history, HT and morbidly Obese.
Increased work of breathing(WOB), anxiety attack while being wheeled out to the vehicle and worked themselves into such a state that there was a LOC and I had to jump in the back and take over treatment.
There was a reasonable tidal volume,
No wheeze but wide spread creps,
Afebrile,
Initially not cyanosed,
BP?? no idea the cuff (obese) wouldn't fit,
Sinus rythym at 96-98bpm,
I gave,
500mcg Adrenaline IMI,
Two nebs,
MBV or IPPV,
Bat called ahead.
GCS at the lowest of 8 (2,1,5) to unloading of 11 (4,1,6) to full 15 when we left.
No backup called for as we were already en route when the deterioration occurred so Padawan and I just swapped places.
Now that was a job to get the juices going, just at the wrong end of the day, bugger.
Be careful out there and I'll see you at the Big One.
Taz
28 July 2009
Second Night.
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1 comment:
Taz, I just have some enquiries about your "Asthma in Extremis" Pt. You have clearly stated that the patient was anxious, so much to the point of being unconscious. You have stated that they have adequate tidal volume. There is no mention of respiratory rates or SpO2%. You have stated at no point did the patient have a wheeze. You have stated that the patient is not a known Asthmatic.
I am wondering then how you have justified you use of Adrenaline and repeat doses of Salbutamol and Atrovent? There is no mention of chest hyperinflation. No mention of high inflation pressures. No mention of minimal air movement. No mention of perfusion. And why did you not attempt expiratory assistance?
In fact there is little evidence to suggest that the patients condition is servere of extreme at all (which is clearly stated in the protocol). Or little evidence to suggest a mild Asthma attack at all.
Let me put to you how you have described the patient's condition a different way.
A non-asthmatic patient, hyperventilating to the point of a decreased LOC, no wheeze, still moving air, not cyanosed, not tachycardic.
Can you justify Adrenaline or repeat Salbutamol and Atrovent?
You have stated the patient had wide spread creps. And you stated you did not take a blood pressure. I want you to now consider the complications of a patient in APO, with a failing left ventricle, to whom you have administered Adrenaline.
I will admit I was not there, but I don't think in any way can you justify your drug administration.
P.S. How is your level 5 application going?
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