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fma08

fma08

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Called for a 79 y.o. female who's not acting her usual self and low BP. (actual call i had) Ask for info and you shall receive (to the best of my knowledge).
 
info please. history, pulse, resp. etc just the basics for now. could be CVA, Orthostatic hypotension making her feel not her self, dehydration, CHF, Myocarial infartion, or she may be on a new medication.
 
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Pt is in a care facility (officially a hospital, but this particular place is renowned where i work as taking not so great care of their patients), had a stroke about a month ago. been in CCU for a while, had been coming around from it, trach was placed and removed by her about a day ago. staff said she fell yesterday. around 1600 noticed a decreasing LOC. (now its about 1830) currently pt is lying on back with feet elevated, staff was kind enough to put a NRB on, snoring/gurgling respirations at about28-30. BP is 50's/30's. Staff had just connected a Dopamine drip as you walked in. no radial pulse present obviously.
 
after they took out the trach if not treated properly she could be experienceing these symptoms from septicemia. is she still on meds or were there any that were discontinued recently? the CVA is she still on meds for that? has she been recieving the proper nutrition?
 
shes on antibiotics and blood thinners, BS is 200 (i think thats where you were headed with the nutrition thing right?) and aside from a 3" stack of papers the staff hands you they dont give you anymore info, (honestly, we fought with them to just get this much)
 
is she feeling any pain in her chest, like when she breaths? (thinking pulmonary emboli after ET tube removal) what was she doing before whe started acting funny?
 
shes unresponsive, sorry, forgot to say that, around 1600 when she started the decreasing LOC her family was there visiting her. she was laying in bed, and it was the family that alerted the staff to her not acting right.
 
Do we have an ECG reading? Does she have Parkinsons?
 
ecg is junctional in the 50's, no to parkinson's
 
Could we have full vitals? You said no radial pulse but what is her heart rate? Does she have a fever? Is her skin blotchy? Red? Gray? I'm thinking sounds like septic shock but tough to tell without vitals.
 
hospital swears no OD, no beta-blockers. been fairly healthy till the stroke. vitals, RR 28-30 snoring/gurgling, pulse matches the monitor, BP now 60's over 40's thanks to the dop. temp of 99.0 (but she had about a dozen blankets on her when we walked in) skin some bruising noted in several spots on her hands and arms and on her head otherwise pale, clammy, cool on the forehead, warm at the core.
 
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So, why did she fall yesterday? Syncopal episode, or did she trip and fall?
 
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or is the hospital staff abusive and neglective?
 
arguably neglective due to past patients.... as for the fall, tripped
 
is she still on her meds for the stroke? is she on meds for the ET? does she show Erythema around the healing ET?
 
she's on blood thinners, antibiotics, and the staff just put her on dopamine... aside from that you don't know (like i said earlier... we had to fight with the staff to get just this much)
 
she's on blood thinners and she had a fall. how do the contusions feel? are they riggid?
 
there's a small hematoma on her head up under one of the contusions, staff said it was there yesterday shortly after she fell, has not gotten any bigger
 
Pupils, reactions, how do they move side to side? up and down?
 
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