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87 year old male unresponsive

by on February 7, 2012

EMS called to a local nursing home for a 87 year old male patient who was unresponsive.  Staff greeted EMS at the door and led them to the patients room.  Pt was found on the floor with a pillow under his head,  He was alert and oriented and looking around as EMS approached.  Staff stated that the patient had a bowel movement and then had one episode of emesis.  Shortly after he became unresponsive which lasted approximately 5 minutes.

Upon exam pt was cold and clammy to the touch but was alert and oriented.  He denies any pain and stated he “felt alright.”  EMS noted that patient appeared pale and staff confirmed that pt normally has good color to his skin.  Radial pulses were present but weak.  His SP02 was 80% on 4lpm NC.  Pt moved to stretcher and he immediately began to vomit.  After vomiting he was placed on 15lpm NRB.  His SP02 now up to 90. 

Blood pressure was 112/60

Past medical history: CABG, Diabetes, A fib, COPD

Medications:Lasix, Advair, Hydrocodone, Toprol, Remeron, Colace

Allergies: Quinine

12 lead obtained

 

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He has a valid EMS DNR and was transported to a local ER and left with staff.

4 hours later EMS called back to the same nursing facility for another pt unresponsive. EMS was led to the same room where they found this same patient whom they had transported earlier, He was in bed and this time truly unresponsive and had agonal snoring respiration’s of about 6pm. The nursing staff were talking about how they could not get his SP02 level up above 60. Both nursing staff and family wanted the patient transported. Pt then stopped breathing completely and was pulseless.
Heart monitor lead II was captured.

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From → Case File

One Comment
  1. Initial 3/12-Lead look like atrial fibrillation, no consistent R-R interval, of note is right axis deviation, S1Q3T3, non-existent R-wave progression.

    Syncope, low O2 sats, signs of right ventricular strain all point to a possible PE.

    Repeat 3-Lead looks like AIVR @ ~110 bpm, AV dissociation appears present. Submassive PE is now massive PE? A 12-lead would help with the rhythm identification.

    If the family would like the patient transported, it would be best to talk to them about the DNR and the likely terminal condition the patient is facing. If they still would like transport for the patient, treat appropriately and make an early notification to the receiving facility to ensure they’re aware of the situation.

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