Thursday, June 22, 2006

Who Let the Dogs Out?

Began the first of what will be six days in a row in the suburbs. Started the day with the same woman from the group home I brought in on Tuesday with the abdominal pain/knee pain complaint. The people at the group home were angry tht the hospital hadn't given them a diagnosis. She was sitting in her chair, feigning unresponsiveness when we got there. On Tuesday she and I had sung "Country Roads" together, so I sat next to her and started whispering in her ear the lyrics to the song, and wouldn't you know, she starts singing: "Country roads, take me home, West Virginia!" and then she ad libbed "Who Let the dogs out!"

She stood, got on our stretcher, and we took her in. The hospital said it was the third day in a row she had been there.

Then I did a 77-year old female with increasing respiratory distress. Only respiratory history was COPD, but she sounded like she had rales. Pale diaphoretic, warm, some pedal edema. Heart rate 108. Respirations in the high 30's. Sats in the 80's. She had a nice straight up wave form. I held off on a treatment and held off on Lasix and just went with 02 by nonrebreather and nitro, and she started breathing much better. Heart rate and respiratory rate improved steadily. Sat came up to mid 90's. Did capnography change the way I practiced? No, but it gave me more confidence in not giving a treatment, which I am always leary of doing when I sense CHF. At the hospital she had a temp of 100.7. I listened to her lungs with the respiratory therapist and she said she heard crackles and decreased sounds in one of the lobes. Only a tiny expiratory wheeze when she took a really deep breath.