you are called to the scene of a patient in respiratory distress who is now unresponsive This is a topic that many people are looking for. thevoltreport.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, thevoltreport.com would like to introduce to you EMS Response To Respiratory Distress Patient. Following along are instructions in the video below:
On this call what were going to is a difficulty breather call. Itss a 73 year old male history of copd. According to the dispatch information and patient has been having a problem really on and off for a few days.
And actually. There was an ambulance at the scene about a day and a half ago. So the patient refused to go to the hospital at that time so were going to this call.
I have not been here before so im not sure what happened when he refused medical assistance. The other day but copd patients some things that we should be thinking about of course are you know nebulize. The treatments.
Possibly mag sulfate. Maybe solu medrol. And even thinking out of the box a little bit about things like cpap you know depending.
Upon your protocol with your option medical control standing orders and what you can request maybe you would run by the doc. The type of medications or even treatment like cpap you might want to go ahead. And consider so start thinking about all that information of course.
The more extreme ends as far as even intubation. So were going to be there in a couple of minutes. Lets know what we found and give you some feedback now the patient actually had some shortness of breath out two days ago.
Called mama. Won. The aimless got there and he felt better when they got this so he refused to go to the hospital.
Not quite. Sure what how he presented to the ambos crew when they got there. But i think possibly in my opinion.
If they took up a little bit of a better history. They might have been more aggressive in their attempts to convince him to go to the hospital now turns out this gentleman. We didnt actually have to do any medications on this patient.
He actually had the same symptoms and complaints when we got there and sending at the previous call. Where he complained of shortness of breath. More on exertion kind of coming and going and more at nighttime and he felt he want to go to the hospital get checked out for it now we got there he wasnt having any obvious transitory distress was little sounds were clear and he was actually satting on the spo2 at 96 on his nasal cannula.
Which was at four liters per minute his whole nasal canula. This is through the compressed air type device that he had now patients like this you know yet thats considered yes theyve got copd. But what other type of issues might be going on with the patient you know this gentleman had a history of afib.
A history of hypertension still smoking. Despite the copd and despite the need for oxygen. All the time.
So you have to think of other things that might be going on with this patient. And it might it might not just be a clear cut copd type patient. Were gonna give a buell treatments and and and calm event.
Treatments or maybe solu medrol. Things like that so treatment for this patient is pretty straightforward. And also got some follow up information for you as well.
But lets just really quickly just talk about treatment now history to me you know its part of the treatment and part of your goal is to kind of get an ongoing history from the patient now in this case. Talking to the patient you know hes urinating. More at night has some mild pedal edema going on and again having his sleep.
He says having some difficulty sleeping having to get up frequently in the night foot to urinate. He seems to be getting short of breath more when hes laying flat shortened to breath more when hes doing any type of activity. Which includes even just simply walking short distances inside of his home so treatment for him again since he wasnt having any active issues going on 0.
02 saturation was good he was pink no cyanosis anything like that most times again were clear you know we didnt need key gene on him. Just a mantra. Mana on the monitor started an iv pretty much critical care for the patient of course.
The airway management. You know its important you want to you know keep an eye out for this type of patient to make sure that that the difficulty reason doesnt thought to you know we emerged during transport and then youre gonna have an issue on your hand. So just you know of course continuing magic manager patient medications.
We did not give any make medications for this patient. Because again. He wasnt presenting with anything.
And didnt really see a need for any medication. Administration for the patient. So its pretty much a just a monitor and transport of the patient.
We did put him on our own nasal cannula treatment. And that actually one of getting his o2 saturation up to the 97 90 percent range about telling that to the hospital and the outcome for the patient was pretty much any mark when we got to the hospital. Without any type of issues going on and actually when we followed up with this patient it turned out that we had something that was beyond just copd.
He was actually admitted for the chf issues. So you know the bigger takeaway for me because this is pretty clear cut you know you just kind of monitor and transport. The patient and the history is more the bigger information and the bigger takeaways you need to get for patients like this to kind of narrow down.
What might actually be going on with this patient you know beyond just the kind of television of getting a copd because thats the cold type and thats the patients primary lets say issue. But you know was all made the best option for this patient. When he called two days ago.
You know maybe a more thorough history taking maybe some more questions may be directed more towards other issues that are going on what you might think is going on other than just zeroing in on a copd issue or zeroing. In on the fact that he was no longer short of breath. Upon your arrival.
So whats army. The best option for this patient you know sometimes we cant always control whats going on with the patient you know what if the patient is having other issues. What if the patient is having chf or another issue going on that we cant actually identify because im not having any active complaints or any active clinical presentation.
Upon your arrival so contract trying to control that what if is taking a good history and figuring out maybe what else might be going on with the patient in the end of course. We do have to respect the patients wishes. So even though rma might not have been the best option two days prior.
You know we do have to respect the patient wishes and you know part of that is you know taking that history and being aggressive and trying to talk the patient into going to the hospital. But in the end again. We have to respect the patients wishes so at that point you know documentation is important for these patients because you dont know what might happen after you leave the patient might flash over he might be fine the rest of the day and in the middle of the night wind up having a cute chf episode.
So you know. While we do want to spec to respect the patient. Wishes would you also want to make sure that when we do an rma for elderly patients that have extensive histories such as afib and hypertension and copd and theyre.
A longtime smoker and a continued smoker and things like that that you do want to make sure you document as best as you can as what you feel is going on and try to document that you did aggressively try to get the patient to go to the hospital. But you are respecting their wishes and then you know my opinion patients like this if you do want up having to arm a the patient. Its always a good idea to make sure that somebody is there with the patient you know family member or neighbors.
Friends or at least get an idea that somebody that the patient knows and is close to at least be following up with the patient later on that day and checking in on them to make sure that they are okay and that their shortness of breath isnt reemerging and theyre unable to calm. I dont want to even get to a phone because of the difficulty breathing. So to me thats the bigger takeaway here again.
The clinical presentation wasnt anything acute was anything that we need to treat aggressively. But maybe the bigger takeaway for me was to kind of understand that our may might not have been the best option try to control what might be going off the patient by getting a better patient history and medication history and things like that and of course in the end. If you have to respect the patient wishes to make sure you document appropriately to make sure that youre covering yourself.
And that the patient understands the repercussions and the the end result of what might happen by them refusing the transportation to the hospital especially with a long type of history. So that to me the bigger takeaway from this this response. So thats it for this first response medic of course.
If you have a response that you did or call that you want to discuss be sure to go ahead and comment below in the comments or send me an email to jay hoffman at ems safety comm you .
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