Good morning all…
It's a beautiful fall Sunday morning, and you and your partner are enjoying an nice cup of coffee. But of course, the tones go off, and you are called to the residence of a 52 year old female, "sick". You recognize the address, you've been there before.
Upon your arrival, you find your patient sitting in a chair in the living room. You remember her. She is a dialysis patient. She does not look well.
She complains of not feeling well. She says she is weak, and has slight shortness of breath. You don't see any labored breathing or accessory muscle use, and she is able to speak in full sentences for now. Her respiratory rate seems ok, as does her pulse.
As you are getting your history, your partner gets a set of vitals.
She tells you that she wasn't feeling great yesterday, and missed her scheduled Saturday dialysis (she is on a Tues-Thurs-Sat schedule).
She thought she would be ok until Tuesday, but it didn't work out that way. She woke up today feeling really rotten and has been progressively feeling worse.
In addition to her renal failure, she also has a history of hypertension and asthma. She has no allergies. She says she has been compliant with her meds, and denies any chest pain or other aches/pains.
Her vitals are as follows:
- HR 78 regular
- BP 158/94
- RR 20
- SpO2 94 on room air
- Lungs very slight expiratory wheezes, but she states she always has that
- Skin unremarkable
You acquire an ECG that looks similar to this one:
You begin packaging your patient.
You are 20 minutes from the closet community hospital.
I am assuming most of you will recognize the above condition and know the available treatments for it.
So, that is not the question.
The questions are these:
Do we treat this patient prehospitally?
To be clear, the question is not "could we" but "should we"?
If we did, What would we use and why?
Is there a benefit to treating in the field versus waiting to hospital arrival?
**There is no obvious "right" answer to this… So, let's discuss it and see where we get. Have at it folks!