• Scene – history from nurse
• En route – vitals, IV attempt, EKG, TT
• Hospital – CT scan, lab work
• Response to treatment – unknown
• Mark Shelton Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Abdominal distension
• Bowel obstruction
• Ascites
• Liver failure
• Congestive hear failure
• Malnutrition
• Neoplasm (malignancy)
• Hepatitis
• Patient states – has had distention for 3 weeks, some pain for 1 week. Has had pedal edema in the past. Had hernia surgery 4 years ago and he thinks that the mesh is causing some of these problems with his stomach. He has had masses in his upper abdomen that migrated to lower abdomen.
• Caregiver states – the nurse practitioner stated that pt has elevated liver enzymes and needs a further work up at hospital.
• GCS – 15
• EKG – possible junctional
• CGB – unk
• Physical findings – Distended ABD, HTN, pedal edema up into knee
The paramedic does a great job of repeating the answers to some questions as the patient at times is difficult to understand. Ascertaining an accurate history, without leading questions, is a critical skill for clinicians.
-Dr. David Spiro
• Gender: Male
• Age: 60 years
• Height: Not Available
• Temperature: 98.5 F/36.9 C
• Blood Pressure: 156/84
• Heart Rate: 68
• Respiratory Rate: 16
• Pulse Oximetry: 99% RA
Distention of abdomen, positional SOB.
• PHM: alcoholism, hep C, cirrhosis of liver, HTN, spinal stenosis.
• Allergies: some kind of a thyazide.
• Dispatch info: Abdomen enlarged.
• Lives in personal residence & uses public transportation.
• Senna, oxycodone, medicinal marijuana
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