Can anyone explain this call?

[Handsome Robb]

I've also been taught that <75%? Pulse oximeters became inaccurate. With that said the point of a patient having sub 75% SpO2 values I don't personally particularly care about the exact number. At that point they're severely hypoxic and require intervention.

@Brandon O I will see if I can find some studies for you.

 

[zzyzx]

What was his BP? If he was having a massive PE, he would have to be hypotensive.

 

[laurenee123]

What was his BP? If he was having a massive PE, he would have to be hypotensive.

On his R arm:
180/110
170/100
168/100


Automatic cuff on his L kept reading 77/54. We switched arms when we were bout to pull into the hospital and then the automatic said there was poor connection. I palped 150.

 

[Brandon O]

Sounds more like a CHF crisis to me.

 

[zzyzx]

Sounds more like a CHF crisis to me.

Yeah, sympathetic induced pulmonary edema. Sounds like the CPAP helped turn him around pretty quickly. Nitro would have helped a lot here too.

Unusual though for a 36-y/o. What was his Hx?

 

[Carlos Danger]

You have to be careful relying too much on the ETc02 reading that you get from a cannula. They can be very inaccurate, especially in someone with a lot of resp distress, because they tend to breath at least partially (if not mostly) through their mouths.

If you are getting a good, consistent waveform then it is fine to use for trending, but just slapping it on and having a low reading, or having the reading abruptly change, doesn't necessarily mean anything. Just like a snapshot Sp02 doesn't mean much.

 

[chaz90]

^ In some ways, the sicker the respiratory patient the harder it is to get any kind of usable EtCO2 waveform.

 

[NomadicMedic]

Any follow on on this call from the ED? I'm curious to hear the dx and outcome.

 

[laurenee123]

Yeah, sympathetic induced pulmonary edema. Sounds like the CPAP helped turn him around pretty quickly. Nitro would have helped a lot here too.

Unusual though for a 36-y/o. What was his Hx?

The only hx he had was that he went to an after hours clinic the week before because he was having mild DB. They gave him an inhaler and some antibiotics. He didn't know the diagnosis or what the antibiotics were. He told us at the hospital that he was on Coumadin because he gets blood clots. That was all he was able to tell us.

 

[laurenee123]

Any follow on on this call from the ED? I'm curious to hear the dx and outcome.

Unfortunately no. I've only been back to that hospital once since and they had a different staff.