• Scene – O2 4L/min NC, cardiac monitor, IV 18g left AC, 0.16 nitro SL
• En route – 12-lead, 0.08mg nitro x2
• Hospital – unknown
• Response to treatment – during transport pt stated relief of breathing difficulty, breath sounds became clear = bilateral.
• Vitals en route – BP-127/74, RR-18, SaO2-97%, HR-90, GCS-15
• Disposition – Pt transported to Salem hospital code-one, with improvement.
• Eric Boyd, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Dyspnea
• Hypoxemia
• Pulmonary edema
• Congestive heart failure
• Pneumonia
• Pulmonary embolus
• Myocardial infraction
• Patient states – Sudden onset of breathing difficulty while relaxing in his chair.
• Denies any change in diet, medications, dialysis, or recent illness.
• No Hx of breathing difficulty
• Bilateral breath sounds = with rales, non-productive cough.
• Upon arrival, patient was sitting in tripod position with labored breathing.
• Skin: pink, warm, dry; no edema noted.
• GCS – 15
• EKG – Sinus tach
The management of patients who use routine dialysis can be complicated. “Fluid overload” symptoms can range from general body edema to pulmonary edema and associated dyspnea. Electrolyte abnormalities such as hyperkalemia and associated arrhythmias should also be considered.
-Dr. David Spiro
• Gender: Male
• Age: 79 years
• Height: Not Available
• Temperature: Not Available
• Blood Pressure: 211/60
• Heart Rate: 104
• Respiratory Rate: 24
• Pulse Oximetry: 88% RA
Sudden-onset difficulty breathing
• PMH: Renal failure, hypertension (HTN)
• Allergies: PCN, sulfa
• Dispatch info: Conscious; difficulty breathing; alert; on kidney dialysis.
• PT lives at home with his wife. Pt states no alcohol or tobacco use.
• Metoprolol, lasix
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