Melclin
Forum Deputy Chief
- 1,796
- 4
- 0
15:34 56yrs Male: Doctor's request (<25mins) - ?Stroke.
O/A: You arrive to find a community care nurse at the door of a run down house.
She provides the following handover:
Alex G Bell is a 57 year old male with a newly placed stoma to whom the nurse has been sent to attend. On her arrival, the pt was complaining of tingling down his left arm and left leg. She called his doctor and he suggested she call the ambulance. She tried to get a blood pressure but had some considerable difficulty, saying she thinks it may be around 85 systolic with a pulse of about 80 but its very hard to palpate. He is a diabetic and his BSL is 5.6
O/E: You enter the house to find a slightly overweight and unkempt man in bed holding a colostomy bag against his stomach. He is alert and oriented and says that he has tingling in both legs and his left arm, and feels nauseated. Pt was discharged from hospital on the previous day after having had a portion of bowel removed due to cancer. He had gone to the toilet in the AM of this current day (~6am) and it, “felt like he was walking on blistered feet”, at which time his tingling sensation started. He had expressed these symptoms to the home care nurse who had activated the ambulance (slightly before the above time). The pt is mildly anxious.
Vitals:
SpO2: unrecordable.
Monitored in Sinus Tach of ~200 (although it does appear that the machine is registering a T-wave as a QRS. Pulse matches the QRS rate).
BP: 90/P
Pulse: 98
Temp: 36.0 (both ears)
Resp rate: 22
BSL: 5.0
Medical Hx:
Type 2 diabetes, hypercholesterolaemia, bowel cancer, post-op bowel resection (14 days previous), pulmonary embolus (a “day or two” before being discharged, they “didn’t give me any drugs or nothing” for the PE). No meds are listed in the PCR although I seem to remember Oxycodone being present. This is probably a hole in the scenario (I didn't run the job and am working from PCR and what I picked up from assisting) but I don’t think meds have anything to do with the outcome.
Physical:
Breath sounds clear and equal bilaterally.
Lower arms, hands and finger are ice cold to touch and have a cap refill of about 4+ seconds, but are pink. Fingernails show mild clubbing.
There are a number of old superficial scars scattered around his chest and arms.
There is a recent surgical wound on his abdomen, slightly to the right of mid line, consistent with his colostomy. The wound appears quite healthy. It is surprisingly well healed, undressed and well perfused.
Both legs are extremely cold to touch and pale with very noticeable cyanosis in the toe nail beds. Very mild pitting oedema is also present in both legs.
After loading:
Once in the ambulance the patient quite suddenly starts to sweat profusely (You could actually see the drips of sweat forming in seconds from nowhere) and states that he “feels like S**t” and is mildly short of breath (reports SOB after prompting for “any problems with your breathing”).
There are three parts to this scenario. This is the first; with the prehospital findings; the second will involve ED findings, firstly with 12-lead and then labs; and the third will involve something else...GO!
O/A: You arrive to find a community care nurse at the door of a run down house.
She provides the following handover:
Alex G Bell is a 57 year old male with a newly placed stoma to whom the nurse has been sent to attend. On her arrival, the pt was complaining of tingling down his left arm and left leg. She called his doctor and he suggested she call the ambulance. She tried to get a blood pressure but had some considerable difficulty, saying she thinks it may be around 85 systolic with a pulse of about 80 but its very hard to palpate. He is a diabetic and his BSL is 5.6
O/E: You enter the house to find a slightly overweight and unkempt man in bed holding a colostomy bag against his stomach. He is alert and oriented and says that he has tingling in both legs and his left arm, and feels nauseated. Pt was discharged from hospital on the previous day after having had a portion of bowel removed due to cancer. He had gone to the toilet in the AM of this current day (~6am) and it, “felt like he was walking on blistered feet”, at which time his tingling sensation started. He had expressed these symptoms to the home care nurse who had activated the ambulance (slightly before the above time). The pt is mildly anxious.
Vitals:
SpO2: unrecordable.
Monitored in Sinus Tach of ~200 (although it does appear that the machine is registering a T-wave as a QRS. Pulse matches the QRS rate).
BP: 90/P
Pulse: 98
Temp: 36.0 (both ears)
Resp rate: 22
BSL: 5.0
Medical Hx:
Type 2 diabetes, hypercholesterolaemia, bowel cancer, post-op bowel resection (14 days previous), pulmonary embolus (a “day or two” before being discharged, they “didn’t give me any drugs or nothing” for the PE). No meds are listed in the PCR although I seem to remember Oxycodone being present. This is probably a hole in the scenario (I didn't run the job and am working from PCR and what I picked up from assisting) but I don’t think meds have anything to do with the outcome.
Physical:
Breath sounds clear and equal bilaterally.
Lower arms, hands and finger are ice cold to touch and have a cap refill of about 4+ seconds, but are pink. Fingernails show mild clubbing.
There are a number of old superficial scars scattered around his chest and arms.
There is a recent surgical wound on his abdomen, slightly to the right of mid line, consistent with his colostomy. The wound appears quite healthy. It is surprisingly well healed, undressed and well perfused.
Both legs are extremely cold to touch and pale with very noticeable cyanosis in the toe nail beds. Very mild pitting oedema is also present in both legs.
After loading:
Once in the ambulance the patient quite suddenly starts to sweat profusely (You could actually see the drips of sweat forming in seconds from nowhere) and states that he “feels like S**t” and is mildly short of breath (reports SOB after prompting for “any problems with your breathing”).
There are three parts to this scenario. This is the first; with the prehospital findings; the second will involve ED findings, firstly with 12-lead and then labs; and the third will involve something else...GO!
