Priority 2 "Breathing Problem" at a SNF

i'm thinking AAA.

how is the patient c/o of diff breathing and but her resp are clean and not labour, but you need to BVM and cpap her?
 
If there is a V/Q mismatch the patient my experience the sensation of difficulty breathing while having minimal easily assessed signs, like wheezing or retractions. The patient was on home CPAP when they arrived, and they switched her to a NRB not a BVM. Which she needed due to a low SpO2.
 
DrParasite said:
i'm thinking AAA.

how is the patient c/o of diff breathing and but her resp are clean and not labour, but you need to BVM and cpap her?
Click to expand...

Not sure where you got BVM and CPAP. Aidey beat me to explaining it.

When I asked her about her breathing she said it was difficult because it hurt to take a deep breath.

Look at it this way, some cardiac patients complain of difficulty breathing or shortness of breath with no increase in their WOB and clear lung sounds.

More labs for you all.

Lactate was 14, BUN and creatinine both were marked high high (HH) don't remember the number but it was way up there, GFR was 17 or 18. Per the ER her glucose was 354 mg/dL, needless to say my glucometer got swapped out after I found that out, I suspected it had been giving me some funny numbers over the last week or so.
 
So sepsis with acute renal failure. From the knee or something else?
 
Robb said:
Not sure where you got BVM and CPAP. Aidey beat me to explaining it.

When I asked her about her breathing she said it was difficult because it hurt to take a deep breath.
Click to expand...
chalk one up to misreading the original post. I saw "needing to have a BM." and thought that said "needing to have BVM."

and oddly enough ProQA would consider "hurts to take a deep breath" to not be cardiac related, and not difficulty breathing.
Robb said:
Look at it this way, some cardiac patients complain of difficulty breathing or shortness of breath with no increase in their WOB and clear lung sounds.
Click to expand...
yeah, I completely misread that original part. my bad :glare:
 
DrParasite said:
chalk one up to misreading the original post. I saw "needing to have a BM." and thought that said "needing to have BVM."
Click to expand...

I'll forgive you this time.

and oddly enough ProQA would consider "hurts to take a deep breath" to not be cardiac related, and not difficulty breathing.
yeah, I completely misread that original part. my bad :glare:
Click to expand...

True, it's not cardiac related, neither was this call. That was just an example I was using to make my point that you can complain of difficulty breathing with no objective signs of respiratory distress.

When I ask her what's bothering her the most and she says "my back hurts and I can't breathe" that's her chief complaint...QA can :censored::censored::censored::censored::censored: and moan all they want but there's nothing they can do about it, that's what she was complaining of. I don't really see how they could have an issue with it though.

Just because the pain is reproducible, despite what EMS classes say, doesn't mean that it can't be cardiac related. My last STEMI was complaining of right sided, sharp, pinpoint chest pain that reproducible on palpation and deep inspiration.

Aidey said:
So sepsis with acute renal failure. From the knee or something else?
Click to expand...

I would assume the knee. That was the doc's opinion. I think the renal failure is secondary to the sepsis and she agreed with that as well.
 
Last edited by a moderator:
Aidey said:
So sepsis with acute renal failure. From the knee or something else?
Click to expand...

If it is not the knee my bet would be UTI.
 
Chase said:
If it is not the knee my bet would be UTI.
Click to expand...

Definitely possible. She didn't have a foley but it's not like you have to have one to get a UTI either.
 
Doesn't the lab confirm she was hyperkalemic? Normal limit is 3.5-5.0.
 
Aprz said:
Doesn't the lab confirm she was hyperkalemic? Normal limit is 3.5-5.0.
Click to expand...

Yessir.

She was hyperkalemic, on the brink of acute renal failure and severely septic.

HyperK and ARF generally go to the party together.
 
Robb said:
She was hyperkalemic, on the brink of acute renal failure and severely septic.

HyperK and ARF generally go to the party together.
Click to expand...

Throw in an ACE inhibitor and Potassium supplements and you have a real party. All things considered I am a little surprised her K wasn't higher.
 
Yey, I got something right on the Internet. Now I just gotta be right in real life.
 
EMT B said:
How would hyper k play a role in the back pain?
Click to expand...

It doesn't. The back pain is most likely due to the AKI which explains the hyper K
 
chase said:
did she have a murmur?

Pluse quality? Carotid, radial, and pedal

ekg? St changes in the inferior leads?

I agree with possible pe or aneurysm; aortic or thoracic.
Click to expand...

+1...........
 
mycrofft said:
+1...........
Click to expand...

Fun fact that some of you may or may not know: Some patients will develop a diasytolic murmur due to acute Aortic regurgitation from a dissecting aneurysm (Or Pseudo-aneurysm to keep Vene happy).

A proximal type A dissection can also directly compress the RCA and produce inferior ischemia/infarct mimicking a MI. I think that is fairly rare.
 
Chase said:
(Or Pseudo-aneurysm to keep Vene happy).
Click to expand...

You can be taught... There is hope.

Moving right along, repeat after me:

"There is no such thing as a fibroid, it is really a leomyoma. There is no fibrous tissue in it, it is all smooth muscle."
 
You must log in or register to reply here.
Back
Top