En RouteIt is 0930 and you are staffing a 2-paramedic transp…
En RouteIt is 0930 and you are staffing a 2-paramedic transporting ambulance. Your unit is dispatched for a 68-year-old female with shortness of breath, nausea, and generalized weakness. She has a history of diabetes, high cholesterol, and high blood pressure. It is a rainy spring night, and the temperature is 65F (18C). The response time is about 8 minutes. There is a community hospital about 15 minutes away, and a level 2 trauma center with most capabilities about 25 minutes away. Dispatch notes report that the patient has been “feeling off” for a few days, and it acutely worsened this morning. On SceneThe husband leads you into the kitchen where you find the patient (60kg) sitting on a chair. She makes eye contact when the crew arrives but appears tired. The patient states she has been “feeling off” for the last 2 days, and this morning she feels like she can’t catch her breath. The patient has no allergies to medications. Her medications include a baby aspirin, atorvastatin, Glucophage, and losartan. The patient’s skin is pale and clammy. There are no signs of trauma, the patient obeys motor commands, and reports she in nauseous. The patient can speak in full sentences and has minimal accessory muscle use when breathing. Eyes are open, pupils are 4mm and reactive to light. The vital signs are BP 142/100, P 98, R 26, SpO2 95% on room air, and T 98F (37C). The blood glucose is 120. The EtCO2 is 38. On further exam you note the patient has scattered fine basilar crackles. POST SCENEThe patient is given aspirin and nitroglycerin on scene. The patient is packaged onto the stretcher in a position of comfort and transport is initiated to the level 2 hospital. En route to the hospital, an IV is initiated. The patient remains fatigued and has an overwhelming sense that something is not right. Vital signs are BP 86/50, P 120, RR 24, SpO2 88% on room air.
Read Details