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Monday, June 7, 2010

A Tale Of Two Diff Breathers

1932 hours. Engine 51, respond for a 60 year old female, shortness of breath. As we're pulling up to the street we see a man waving his arms hysterically. Once we get to the corner he breaks into a sprint to get to his house, a half block away. Usually when we are greeted by hysterical it's something serious.

As we walk inside the house we're we find our patient standing in the living room complaining that she can't breath. She had recently been diagnosed with lung cancer. Her vitals are all looking good with the exception of her respiratory rate which was a little high until you got the patient thinking about something else. She started talking about her back pain that she had since she now had to sleep in a recliner, What it came down to was an anxiety attack. By the time that she was loaded in the ambulance she was doing well.

0403 hours. Engine 51, respond to the corner of Central and Main for a female having shortness of breath at a gas station. Pulling up we see AMR on scene starting to treat the patient. We decide to stick around to see if they need any help.

They quickly move the patient to the back of the ambulance. There the patient becomes extremely agitated. She ended up getting sedated so that they could treat her. When AMR first arrived on scene a bystander said that the patient was having a panic attack. AMR continued to go down this route of thinking for a while. As the other medic on my crew and I stood at the back and the ambulance, we both agreed that this was something more serious than a panic attack. Finally we got some vitals:

HR- 118
RR- 36
BP- 218/104
SpO2- 98% on room air
Lung sounds- Rales in the bases on the right side
Sinus tach with frequent unifocal PVC's
12 lead unremarkable
Blood sugar- 293
Capnography- 55

The patient was complaining of shortness of breath (sudden onset) and then had severe abdominal pain and nausea. No chest pain. She had no medical history (probably because she never went to the doctor and wasn't ever diagnosed), took no medications and had no allergies.

I ended up riding in to the hospital on this one just in case. At first I was thinking a cardiac event but by the end of the call I think it was flash pulmonary edema. I think maybe the lung sounds that were reported weren't accurate. Normally I would have some better patient history but the patient was well and truly sedated.

We ended up treating the rales. Nitro and CPAP. I managed to get a line in the back of the box. We made it to the hospital without any problems.
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