Today was horrible! I was crashing today, I was right before passing out at Globus (German mall) today. I am going to type out the signs and symptoms for a friend of mine so she can tell me what she would have done for me as a medic on duty. Jeniva Deziaray Griego, how would you handle the following pt and before you ask yes this is how i presented to day. any one that would like to try please give it a crack. :) The following is also a picture of how my day went around 1800. Most of my day has been fine just extremely fatigued. I was so low on nutrition and so fatigued that my body was beginning to shutdown. My BP was low, my pulse (carotid) was weak and thready at a rate of greater than 45 but less than 60, my skin was cool and clammy, delayed capillary refill, deep, fast, labored breathing RR 24, mild altered mental status,weak grip, poor color (pallor), severe pluralistic chest pain that radiated from severe abdominal pain (LUQ, LUQ, RUQ), with moderate abdominal distention, weak limbs and being mostly supported by my mom, there are 6 surgical incisions located in various places on the abdomen and at varying sizes and at unknown dept, some of those incisions are weeping/ draining from under the dermabond that is holding them shut, the Pt is complaining of being to hot and on the verge of a nose bleed. O=n 15 minutes, P= heat, physical exertion, Q= sharp stabbing pain in abdomen and dull in chest , R= chest, S= 8/10 (Pt is in obvious signs of moderate too extreme pain), T= unknown, A= bee/Wasp, M= roxicet 10mg (narcotic) with 650mg of acetaminophen(Tylenol) every 4 hours, diphenhydramine (Benadryl) every 4 hours Ondansetron 8mg ever 8 hours, Epi-pen .3 *2 PRN {(as needed) (pt tells you his surgeon has forbidden him to take pills of any)}, P= severe uncontrolled GERD for 20 years treated surgically a week ago with a Nissen Fundoplication other medical ailments exist but are not pertinent, L= solids over a week ago but has not had any for over a week, Pt did however have a 8 oz liquid vitamin shake about 4 hour prior, E= walk around in a hot mall unable to consume anything. Secondary assessment shows evidence of a sore throte (consistent with recent placement/removal of a intubation tube) and tiny laceration inside the nose (consistant with a nasogastric tube placement and removal) eyes are pin tip and minorly reactive to light. "rice crispies" were found in my shoulders (air bubbles) and ribs, pt will not let you push on his abdomen, skin on the legs have minor laceration which the pt say he got from excessive scratching. vital sign are constantly getting worst at a slow and steady pace. how would you treat this pt and what would you do for him? any special precation? if you need or want more info just as i will give it to you as long as you try top answer the question.
Posted on: Wed, 07 Aug 2013 22:32:35 +0000
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