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ED case 8+2 minute case
65 year old male comes to the ED for shortness of breath and significant respiratory distress. Worsening cough with sputum production. PMH history of copd and smoker.
Vitals: temp 98
HR: 88
RR: 25
Bp: normal
Following is the approach I would take:
1) Stabilizing orders. Even though patient is hemodynamically stable, respiratory status along with age points toward stabilizing orders:
a. IV access, pulse ox, oxygen, cardiac monitor, bp monitor, EKG. Am I wrong to add EKG here?
2) Physical exam
a. HEENT, Cardio, respiratory
i. Exam came back normal except for: Increased AP diameter, decrease breath sounds bilateral, wheezing and rhonchi, prolong expiration, hyper resonance to percussion
3) Move the clock to get to the first order window.
a. Ordered: albuterol, chest x-ray, abg
i. Question: Can I order (cbc, bmp, sputum culture, steroids, ABx) on the same screen as chest x-ray, abg, albuterol or do I need to order these on a separate screen?
65 year old male comes to the ED for shortness of breath and significant respiratory distress. Worsening cough with sputum production. PMH history of copd and smoker.
Vitals: temp 98
HR: 88
RR: 25
Bp: normal
Following is the approach I would take:
1) Stabilizing orders. Even though patient is hemodynamically stable, respiratory status along with age points toward stabilizing orders:
a. IV access, pulse ox, oxygen, cardiac monitor, bp monitor, EKG. Am I wrong to add EKG here?
2) Physical exam
a. HEENT, Cardio, respiratory
i. Exam came back normal except for: Increased AP diameter, decrease breath sounds bilateral, wheezing and rhonchi, prolong expiration, hyper resonance to percussion
3) Move the clock to get to the first order window.
a. Ordered: albuterol, chest x-ray, abg
i. Question: Can I order (cbc, bmp, sputum culture, steroids, ABx) on the same screen as chest x-ray, abg, albuterol or do I need to order these on a separate screen?
