18G
Paramedic
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43 yo male is at a cancer treatment center receiving a blood transfusion (1 unit PRBCs) for low H&H secondary to cancer complication. Patient received the entire unit of blood at which time he became SOB and faint crackles were noted in the lung bases. RN reports and patient gives impression of non-compliance with medical treatment and specifically with not taking his Lasix. Patient is also on a sodium restricted diet and patient is morbidly obese at 340lbs. Some lower extremity edema is present. Neck is obese so it's difficult to assess JVD. Patient did say he didn't sleep well last night due to waking up SOB. RN advised that patient was a little short winded when he arrived.
Patient has no CHF history but does have renal failure history of which was reported to be acute and now resolved. My impression is a volume overload status which is causing the SOB and crackles. In other words CHF. BP wasn't high and was 120s/70s, HR 110, RR 28. SpO2 99% on 2lpm.
ETA to the hospital was literally one minute across the parking lot.
Would you have given nitro to this patient to expand the vascular container to better accommodate the excess volume and reduce the pulmonary vasculature pressure even though patient is not hypertensive?
Thoughts?
Patient has no CHF history but does have renal failure history of which was reported to be acute and now resolved. My impression is a volume overload status which is causing the SOB and crackles. In other words CHF. BP wasn't high and was 120s/70s, HR 110, RR 28. SpO2 99% on 2lpm.
ETA to the hospital was literally one minute across the parking lot.
Would you have given nitro to this patient to expand the vascular container to better accommodate the excess volume and reduce the pulmonary vasculature pressure even though patient is not hypertensive?
Thoughts?