- Joined
- Nov 18, 2002
- Messages
- 5,216
- Reaction score
- 2,431
First patient of shift-
60 something year old female with terrible hx of anaphylaxis and asthma calls 911. "I can't breathe and I can't get to my epi-pen," then, halfway through her address stops talking. Medics go to home after 3-4 minutes of driving. Knock on door. No answer. Find door unlocked. Go in and find a lady passed out in a chair, guppy breathing, ashen, sats of 25%. Start bagging. Get sats up within a couple of minutes. Give epi IM. Glucose fine. Pt totally unresponsive. Find wheelchair bound husband in back room. Bring her to my ED.
Totally unresponsive to sternal rub, but breathing shallowly and easily bagged. Good vitals. Intubated. Initial ETCO2 75. Hyperventilated a bit until that got down below 40. A bit hard to oxygenate so 100% O2 and PEEP of 10 on vent which works. Pt wheezy so given solu-medrol, atrovent, albuterol, benadryl, and pepcid. Pt coughing a bit on tube so started propofol drip at 5. Pt dumps pressure to 65/39. Take off vent and bagged. Given 2 liters of fluids and propofol drip stopped. Pressure comes up and pt starts coughing on tube again so drip started again and put back on vent with PEEP of 7.5 With PCO2 of 40, pH is 7.06. Lactate 14. Pt's family finally arrives. She had moved her arms a bit as well and pupils reactive but sluggish. Transferred to ICU.
Get call from ICU 4 hours later- pt extubated and talking. The medic was back in with another patient so we went down to see her together. She looks great, chatty cathy. Family super grateful. She gives us each a big hug and kiss.
Gotta love days like that.
60 something year old female with terrible hx of anaphylaxis and asthma calls 911. "I can't breathe and I can't get to my epi-pen," then, halfway through her address stops talking. Medics go to home after 3-4 minutes of driving. Knock on door. No answer. Find door unlocked. Go in and find a lady passed out in a chair, guppy breathing, ashen, sats of 25%. Start bagging. Get sats up within a couple of minutes. Give epi IM. Glucose fine. Pt totally unresponsive. Find wheelchair bound husband in back room. Bring her to my ED.
Totally unresponsive to sternal rub, but breathing shallowly and easily bagged. Good vitals. Intubated. Initial ETCO2 75. Hyperventilated a bit until that got down below 40. A bit hard to oxygenate so 100% O2 and PEEP of 10 on vent which works. Pt wheezy so given solu-medrol, atrovent, albuterol, benadryl, and pepcid. Pt coughing a bit on tube so started propofol drip at 5. Pt dumps pressure to 65/39. Take off vent and bagged. Given 2 liters of fluids and propofol drip stopped. Pressure comes up and pt starts coughing on tube again so drip started again and put back on vent with PEEP of 7.5 With PCO2 of 40, pH is 7.06. Lactate 14. Pt's family finally arrives. She had moved her arms a bit as well and pupils reactive but sluggish. Transferred to ICU.
Get call from ICU 4 hours later- pt extubated and talking. The medic was back in with another patient so we went down to see her together. She looks great, chatty cathy. Family super grateful. She gives us each a big hug and kiss.
Gotta love days like that.
