My instructor canceled class, again. So she sent us these case studies. We are not going to be graded on them, so its ok to help me. She said that we are going to talk about them tomarrow night in class, but, for reasons that I would like to keep to myself, I would rather yall go over what I think first. Oh, and I know, she is not good at spelling or gramar, but you can get the idea.
The last two I feel really confident about. The first one....:wacko: :huh:
Case Study 1
You respond to a 52 y.o. woman complaining of dyspnea, especially bad at night accompanied by a nocturnal productive cough and fatigue. Your general impression is that he is “sick”. You patient assessment reveals that she is tachypneic at 32/min and tachycardic at 110/min. She is also hypertensive at 162/102, A & O x 3 and confused, slightly pale with cyanotic lips, PERRL and has good sensory, motor and a cap-refill or 4 seconds. She feels nauseous, has some abdominal pain, sunken eyes, is weak and has been urinating frequently. She has not had much of an appetite but has been drinking tea, water and some hot chocolate. She is allergic to sulpha drugs, takes lipitor 10 mg, lasix 10 mg and crestor 5 mg daily for hypertension and high cholesterol. She is also diabetic type II and her BG levels read 72. She also takes nitroglycerine for her heart when needed and one baby aspirin daily. Upon auscultation you detect rales her lower lobes.
What is her condition and what is your treatment?
Possible Hypoglycemia/COPD
This patient is possibly hypoglycemic, as shown by a BGL of 72. It is possible that hypoglycemia is the cause of all of her signs/symptoms. Lowered LOC, confusion, and abdominal pain are signs of hypoglycemia. It is possible that she has chronically overdosed on Aspirin. As that would account for most of her signs and symptoms.
She does have possible COPD, which would account for the rales, cyanosis, cough and dyspnea. Her mental status could be altereted due to hypoxia.
I feel that it would not be wise to try and decided which one is the cause. I would transport with highflow 02, and consider D50 or an alternate method of raiseing her BGL.
Case Study 2
You respond to an 80 y.o. man complaining of weakness. Your patient assessment reveals that he is tachycardic at 122/min, tachypneic at 36/min, A & O x 4, diaphoretic, pale, cool and clammy, peripheral edema, ascites and had a bout of epistaxis last night. He is allergic to penicillin, is on Zocor daily, Nitrostat when needed, has a nitro patch, baby aspirin daily, Albuterol 2 puffs morning and night, Flovent 1 puff morning and night, 40 mg lasix and a fiber pill daily. He has not had much of an appetite but has been drinking plenty of fluids.
What is his condition and what is your treatment?
Possible over-use of MDI
Weakness could be any number of things; age related, heart or lung related, it is also possibly an effect of the MDI usage. Tachycardia is a side effect of Albuterol, as is tachypnea. Pale, cool, and clammy skin is an effect of Albuterol, is could also be from his under-lying heart condition. Peripheral edema and ascites are most likely per-existing conditions, and have no relevance to the current situation. This is evidenced by his use of Zocor, Nitrostat, Aspirin, Lasix, and a nitro patch. Epistaxis is a side-effect of Albuterol, as is loss of appetite. His use of two MDIs daily is concerning. In general only one should be used daily, with a fast acting inhaler for sudden onset of symptoms.
Interventions is this situation are limited to high-flow 02 via a non-rebreather mask at 15lmp. Transport.
Case Study 3
You respond to a 3 y.o. female who’s mother is complaining of dyspnea accompanied by a harsh high-pitched cough. You patient assessment reveals that she appears sick is tachypneic at 38/min, tachycardic at 118/min normal blood pressure, is running a fever of 102 degrees has a cough and is drooling and is pale and has cyanotic lips. She is also congested and has signs and symptoms of a cold.
What is her condition and what is your treatment?
Possible Epiglottis
The harsh, high pitched, cough is suggestive of an upper-airway obstruction. The elevated respiration rate suggests insufficient respiratory function. The heart rate is within normal limits for a 3 year old. Fever, cough, and the signs/symptoms of a cold are all consistent with Epiglottis. Drooling is cause by the in-ability to swallow. Cyanosis is cause by the airway being obstructed. Pale is a sign of being sick, also of cyanosis.
There is not much an EMT-B can do in this situation. Provide high-flow 02, via a non-rebreather mask at 15lpm. Transport in a position of comfort. Be ready to provide ventilation via BVM should respirations become even more insufficient.
The last two I feel really confident about. The first one....:wacko: :huh:
Case Study 1
You respond to a 52 y.o. woman complaining of dyspnea, especially bad at night accompanied by a nocturnal productive cough and fatigue. Your general impression is that he is “sick”. You patient assessment reveals that she is tachypneic at 32/min and tachycardic at 110/min. She is also hypertensive at 162/102, A & O x 3 and confused, slightly pale with cyanotic lips, PERRL and has good sensory, motor and a cap-refill or 4 seconds. She feels nauseous, has some abdominal pain, sunken eyes, is weak and has been urinating frequently. She has not had much of an appetite but has been drinking tea, water and some hot chocolate. She is allergic to sulpha drugs, takes lipitor 10 mg, lasix 10 mg and crestor 5 mg daily for hypertension and high cholesterol. She is also diabetic type II and her BG levels read 72. She also takes nitroglycerine for her heart when needed and one baby aspirin daily. Upon auscultation you detect rales her lower lobes.
What is her condition and what is your treatment?
Possible Hypoglycemia/COPD
This patient is possibly hypoglycemic, as shown by a BGL of 72. It is possible that hypoglycemia is the cause of all of her signs/symptoms. Lowered LOC, confusion, and abdominal pain are signs of hypoglycemia. It is possible that she has chronically overdosed on Aspirin. As that would account for most of her signs and symptoms.
She does have possible COPD, which would account for the rales, cyanosis, cough and dyspnea. Her mental status could be altereted due to hypoxia.
I feel that it would not be wise to try and decided which one is the cause. I would transport with highflow 02, and consider D50 or an alternate method of raiseing her BGL.
Case Study 2
You respond to an 80 y.o. man complaining of weakness. Your patient assessment reveals that he is tachycardic at 122/min, tachypneic at 36/min, A & O x 4, diaphoretic, pale, cool and clammy, peripheral edema, ascites and had a bout of epistaxis last night. He is allergic to penicillin, is on Zocor daily, Nitrostat when needed, has a nitro patch, baby aspirin daily, Albuterol 2 puffs morning and night, Flovent 1 puff morning and night, 40 mg lasix and a fiber pill daily. He has not had much of an appetite but has been drinking plenty of fluids.
What is his condition and what is your treatment?
Possible over-use of MDI
Weakness could be any number of things; age related, heart or lung related, it is also possibly an effect of the MDI usage. Tachycardia is a side effect of Albuterol, as is tachypnea. Pale, cool, and clammy skin is an effect of Albuterol, is could also be from his under-lying heart condition. Peripheral edema and ascites are most likely per-existing conditions, and have no relevance to the current situation. This is evidenced by his use of Zocor, Nitrostat, Aspirin, Lasix, and a nitro patch. Epistaxis is a side-effect of Albuterol, as is loss of appetite. His use of two MDIs daily is concerning. In general only one should be used daily, with a fast acting inhaler for sudden onset of symptoms.
Interventions is this situation are limited to high-flow 02 via a non-rebreather mask at 15lmp. Transport.
Case Study 3
You respond to a 3 y.o. female who’s mother is complaining of dyspnea accompanied by a harsh high-pitched cough. You patient assessment reveals that she appears sick is tachypneic at 38/min, tachycardic at 118/min normal blood pressure, is running a fever of 102 degrees has a cough and is drooling and is pale and has cyanotic lips. She is also congested and has signs and symptoms of a cold.
What is her condition and what is your treatment?
Possible Epiglottis
The harsh, high pitched, cough is suggestive of an upper-airway obstruction. The elevated respiration rate suggests insufficient respiratory function. The heart rate is within normal limits for a 3 year old. Fever, cough, and the signs/symptoms of a cold are all consistent with Epiglottis. Drooling is cause by the in-ability to swallow. Cyanosis is cause by the airway being obstructed. Pale is a sign of being sick, also of cyanosis.
There is not much an EMT-B can do in this situation. Provide high-flow 02, via a non-rebreather mask at 15lpm. Transport in a position of comfort. Be ready to provide ventilation via BVM should respirations become even more insufficient.
