adamjh3
Forum Culinary Powerhouse
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Alright, this one's going off memory, and it kind of had me baffled. I'll wait to unveil what my impression was until I get a couple replies.
It's 1700 on an overcast Monday afternoon and you're nearing the end of your shift on a BLS truck staffed with two EMTs. You're sent from your post at the beach to an urgent care about 30 minutes inland from your location for a transfer to the emergency room. The Motorola gods inform you that you will be attending to a 27yo Female complaining of abdominal pain.
You arrive on scene and are greeted in the crowded lobby by a woman who looks to be in her late thirties to early forties. She stands up, asks if you're there for her, you ask her name and find out that she is indeed the patient you are here for. While you and your partner are lowering the gurney to get her on she says "No, that's embarrassing, I can just walk." After a shrug and a "well, we already have it set up for you" from your partner she hops on the gurney.
The staff at this location makes a point of being generally unhelpful and dodgy just last week you came to this location, the chief came out as "back pain" when you arrived on scene you found out it was chest pain with associated SOB from your patient, the doctor said the patient complained of neither to him only to find out that very same doctor marked those two items on the transfer sheet, and that wasn't the first time you've had an incident like that at this particular facility. All you get from them is that the Doctor wanted her to be seen at the closest ER and a recent set of vitals which are
P: 84
R: 18 with an SpO2 of 96% on room air
BP: 132/90
You opt to begin your assessment in the truck so as to give the patient a bit of privacy and begin your questioning while your partner obtains vitals. You determine that despite how worn she looks, she is indeed 27. You notice your patient is belching loudly once or twice each minute, each belch is followed by a gag or cough which sounds almost like a dry heave. When asked about this frequent belching, the patient states she's been doing this since this morning and that her "stomach feels like it has lots of stuff in it." She denies nausea or vomiting.
Your patient states she came into the urgent care to see the doctor about getting her Percocet prescription for back pain filled. her last script ran out two nights ago, she states she takes "painkillers every day" but is unable to give you a dosage. Her last intake of medication was a vicodin yesterday morning which she said she received a three day supply from another doctor to hold her until she could get her percocet filled.
After some more prodding you're able to find out that your patient has been experiencing abdominal pain which has steadily gotten worse since last night, the pain is dull and throbbing at the midline lower abdomen, non radiating at about a 7/10 on the pain scale. Your patient states she has also been experiencing some minor rectal bleeding. As described by the patient the blood is a dark red, the bleeding occurs when she urinates, but she is positive that she is bleeding from her rectum and not her vagina. She states the bleeding is light, only small amounts of spotting when she wipes after urinating. She states the amount of blood is similar to her periods, which are described as "light". She states she finished her last menstrual cycle a week ago.
The patient reveals that she has not had a bowel movement in several days, and that her appetite has decreased significantly over the last week. She last ate a "small amount of food" around 2000 the previous night.
The patient has a Hx of Chronic back pain and hepatitis C, along with a few stomach ulcers, the most recent being 3yrs ago.
Pt. is allergic to shellfish, denies known medication allergies
Pt. denies any medications besides the percocet which she has been taking daily for "at least a year"
At this point your partner passes her vitals to you
P:80, strong and regular at the radial site
R: 16 full and effective with clear lungs
BP: 134/90
E: PERRL @ 3mm
Pt. is A&Ox3
Skins: Pink warm and dry
Bowels sound "sluggish"
The abdomen does not feel distended, firm, or otherwise abnormal. Patient denies any changes in the quality or quantity of abd. pain upon palpation.
En route to the ER the patient's status does not change, no interventions are given other than giving her a basin just in case that belching turns into vomit.
Thoughts?
It's 1700 on an overcast Monday afternoon and you're nearing the end of your shift on a BLS truck staffed with two EMTs. You're sent from your post at the beach to an urgent care about 30 minutes inland from your location for a transfer to the emergency room. The Motorola gods inform you that you will be attending to a 27yo Female complaining of abdominal pain.
You arrive on scene and are greeted in the crowded lobby by a woman who looks to be in her late thirties to early forties. She stands up, asks if you're there for her, you ask her name and find out that she is indeed the patient you are here for. While you and your partner are lowering the gurney to get her on she says "No, that's embarrassing, I can just walk." After a shrug and a "well, we already have it set up for you" from your partner she hops on the gurney.
The staff at this location makes a point of being generally unhelpful and dodgy just last week you came to this location, the chief came out as "back pain" when you arrived on scene you found out it was chest pain with associated SOB from your patient, the doctor said the patient complained of neither to him only to find out that very same doctor marked those two items on the transfer sheet, and that wasn't the first time you've had an incident like that at this particular facility. All you get from them is that the Doctor wanted her to be seen at the closest ER and a recent set of vitals which are
P: 84
R: 18 with an SpO2 of 96% on room air
BP: 132/90
You opt to begin your assessment in the truck so as to give the patient a bit of privacy and begin your questioning while your partner obtains vitals. You determine that despite how worn she looks, she is indeed 27. You notice your patient is belching loudly once or twice each minute, each belch is followed by a gag or cough which sounds almost like a dry heave. When asked about this frequent belching, the patient states she's been doing this since this morning and that her "stomach feels like it has lots of stuff in it." She denies nausea or vomiting.
Your patient states she came into the urgent care to see the doctor about getting her Percocet prescription for back pain filled. her last script ran out two nights ago, she states she takes "painkillers every day" but is unable to give you a dosage. Her last intake of medication was a vicodin yesterday morning which she said she received a three day supply from another doctor to hold her until she could get her percocet filled.
After some more prodding you're able to find out that your patient has been experiencing abdominal pain which has steadily gotten worse since last night, the pain is dull and throbbing at the midline lower abdomen, non radiating at about a 7/10 on the pain scale. Your patient states she has also been experiencing some minor rectal bleeding. As described by the patient the blood is a dark red, the bleeding occurs when she urinates, but she is positive that she is bleeding from her rectum and not her vagina. She states the bleeding is light, only small amounts of spotting when she wipes after urinating. She states the amount of blood is similar to her periods, which are described as "light". She states she finished her last menstrual cycle a week ago.
The patient reveals that she has not had a bowel movement in several days, and that her appetite has decreased significantly over the last week. She last ate a "small amount of food" around 2000 the previous night.
The patient has a Hx of Chronic back pain and hepatitis C, along with a few stomach ulcers, the most recent being 3yrs ago.
Pt. is allergic to shellfish, denies known medication allergies
Pt. denies any medications besides the percocet which she has been taking daily for "at least a year"
At this point your partner passes her vitals to you
P:80, strong and regular at the radial site
R: 16 full and effective with clear lungs
BP: 134/90
E: PERRL @ 3mm
Pt. is A&Ox3
Skins: Pink warm and dry
Bowels sound "sluggish"
The abdomen does not feel distended, firm, or otherwise abnormal. Patient denies any changes in the quality or quantity of abd. pain upon palpation.
En route to the ER the patient's status does not change, no interventions are given other than giving her a basin just in case that belching turns into vomit.
Thoughts?
