What could I have done differently for this call?

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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So we were dispatched for a 77 year old female indigestion. We get there pt is conscious and alert holding an ice pack to her chest and respirations in the 30s complaining of shortness of breath. No hx besides anxiety and high BP. Grab a set of vitals and pts sat is 84 on room air. Pt is getting herself worked up as well stressing about everything in the room but there is definitely something going on and doesn't seem like anxiety attack. Applied non rebreather 15 lpm of o2 pt sat is 95. Pt presents with cough and wheezing. We call for als for an intercept but als is unavailable. Bring pt to hospital.

When we bring our next call to hospital saw that pt is on cpap and going to isolation and icu. Didnt get to find out exactly what was going on but is there anything I should of done differently ?

Would bvm been a better route to go?
Low says could be due to what's been said: tachypnea and shallow resps. A brown paper bag to slow her down might have helped to improve her says. Obviously, the NRB helped. Don't base your question on what happened after pt got to the hospital. Apples and oranges.
 

ffemt8978

Forum Vice-Principal
Community Leader
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Low says could be due to what's been said: tachypnea and shallow resps. A brown paper bag to slow her down might have helped to improve her says. Obviously, the NRB helped. Don't base your question on what happened after pt got to the hospital. Apples and oranges.
Are paper bags even allowed anymore?
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
548
142
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I have seen several cases of AKI after a single dose of toradol in patients who were previously healthy. A higher dose of toradol does increase the risk of kidney insult.
Yep.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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akflightmedic

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No to the brown paper bag. No to the non-rebreather turned off.

What is taught and what SHOULD be encouraged is actually talking to your patient and coaching them to slow their breathing. Decrease stimuli, including your tone, pitch and actions...coach them in the nose, out the mouth. It is amazing how quick this works when done correctly. Too many "old school" types who want to dismiss science, not take the extra effort to coach, and instead use dated and/or unsafe practices.
 

E tank

Caution: Paralyzing Agent
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No to the brown paper bag. No to the non-rebreather turned off.

What is taught and what SHOULD be encouraged is actually talking to your patient and coaching them to slow their breathing. Decrease stimuli, including your tone, pitch and actions...coach them in the nose, out the mouth. It is amazing how quick this works when done correctly. Too many "old school" types who want to dismiss science, not take the extra effort to coach, and instead use dated and/or unsafe practices.
If by "old school" you mean poorly trained, I think I know some of those in their 20's and 30's... and would that hyperventilation were the worst thing they'd take care of...
 

Tigger

Dodges Pucks
Community Leader
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No to the brown paper bag. No to the non-rebreather turned off.

What is taught and what SHOULD be encouraged is actually talking to your patient and coaching them to slow their breathing. Decrease stimuli, including your tone, pitch and actions...coach them in the nose, out the mouth. It is amazing how quick this works when done correctly. Too many "old school" types who want to dismiss science, not take the extra effort to coach, and instead use dated and/or unsafe practices.
While this sounds like some sort of significant respiratory event with some anxiety on top, your point still stands.

Anxiety exacerbations are a relatively common EMS call. And yet we teach no one how to actually help these patients during their education. I learned to from a preceptor and now as I precept folks, I realize they're in the same boat. They just have no idea what to do. Square breathing...it works.

Obviously some patients have an intrinsic reason for tachypnea and that should be mostly left alone. But for the most part...
 

johnrsemt

Forum Deputy Chief
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Brown paper bags stopped working when they put a wax-like substance in with the paper, so they were more airtight so that the food that was in them for lunch would last longer: and when a patient breathed into them when they were hyperventilating they were getting almost no fresh air.

The dose intervals of Toradol I was getting in the ED may have been wrong, it was about 6 years ago. The Fentanyl doses were correct. They finally put me on a pump with a syringe with Fentanyl/NS in it for 50mcg every 30 minutes. They kept me for 3 days and released me when my O2 sats would stay above 85% on room air. Pneumonia aggravated by asthma and a broken rib (with a 2nd cracked rib) from coughing so much. I hate the pneumonia shot (which I got 2 days ago) because it feels like they used a dull railroad spike to jab it into my arm; but I haven't gotten pneumonia since.
 

TN805

Forum Ride Along
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So we were dispatched for a 77 year old female indigestion. We get there pt is conscious and alert holding an ice pack to her chest and respirations in the 30s complaining of shortness of breath. No hx besides anxiety and high BP. Grab a set of vitals and pts sat is 84 on room air. Pt is getting herself worked up as well stressing about everything in the room but there is definitely something going on and doesn't seem like anxiety attack. Applied non rebreather 15 lpm of o2 pt sat is 95. Pt presents with cough and wheezing. We call for als for an intercept but als is unavailable. Bring pt to hospital.

When we bring our next call to hospital saw that pt is on cpap and going to isolation and icu. Didnt get to find out exactly what was going on but is there anything I should of done differently ?

Would bvm been a better route to go?
Good for you for not falling into the group "oh it's just an anxiety attack". You don't see O2 sats of 84 with this. Her "anxiety is from hypoxia and going to high flow O2 was the right choice. Sudden onset of wheezing with no history I would be thinking CHF and investigate that. Kind of looks from your follow-up that may have been the case. WELL done on not getting caught in the anxiety trap.
 

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