Patient Assessment - Respiratory distress - page 2

i have long had some disagreements with the way assessment is traditionally taught. i don't believe that it is automatic that if you know the normal you can recognise the abnormal. sometimes... Read More

  1. by   karenG
    em I wouldnt know where to start!!! I work in primary care- not something I see very often................

    Karen

    I am so impressed and learning so much!!
  2. by   suehp
    I agree with Karen!

    Wouldnt know where to start as I work in a Nursing Home but this is great for learning. THANK-YOU

    Sue
  3. by   cab631
    When I was in BFE with that patient, helicopter ambulance wasn't flying due to altitude and weather, ground ambulance wasn't an option either for the same reason. The patient survived BTW, and I had an exciting night. Learned a lot when I realized it was just me and not a lot of technology.
  4. by   nicudaynurse
    Gwenith,

    I LOVE these threads!! Keep them coming!!
  5. by   nowplayingEDRN
    Kudos cab631!! As laura Gasparis says, "It takes a nurse to save your life."

    Karen and Sue...

    It's okay that you don't know where to begin. We are all here to learn from this scenario together.....so take a stab and jump in the fun
  6. by   gwenith
    EXactly Untamed spirit I might have started it but because I am ICU not primarily ER I have learnt as well! Learning is a path we all take.

    Now I is 3 am in the morning and Thargomindah is having the first rain it has recieved in 5 years so it has been impossible to evacuate this patient. Throughout the night his respiratory rate has increased you can hear sputum rattling in his chest and although he is not in a lot of pain on the pca - 2/10 he complains that coughing is 10/10! He will not deep breathe well despite encouragement and is not coughing productively. He is self - administering between 5 - 10 mgms per hour and dozing off between PCA doses.

    The X-ray you were able to get earlier shows a small self-contained pneumothorax at the top of the right lung. Nice Dark area just visible which won you a kudos for spotting it from the RFDS.

    His sats have been dropping slowly over the night you feel that sputum retention may be part of the problem and if you can get him enough pain relief to cover the coughing you might get him through. The hospital does have some ENTONOX (50% Oxygen 50% nitrous oxide) which may give him the pain cover he needs. Could you use this in this situation?





    By the way here is link to the real Thargomindah
    http://www.queenslandholidays.com.au...argomindah.cfm As you can see it is really remote!!!
  7. by   gwenith
    Hmmm Okay I mad this last bit of the scenario a bit too hairy. What was I thinking? Oh! Yeah! = Pointo tbe made!

    You can and I have in the past used entonox for pain relief for fractured ribs - not used much since the advent of better regional and epidural blocks but if cought out without recourse it is worth a think. From personal expereince it rapidly converts someone who is will not deep breathe and cough to someone who, as soon as they realise that the deeper they breathe the the more pain relief they get. Often small isolated hospitals carry things like entonox where the more technological interventions are not available. Unfortunately Entonox would not be able to be used in this situation as it can convert a small pneumothorax to a larger one. That is the point of the last question.

    Okay now on to a new game!
  8. by   nowplayingEDRN
    I have to say gwenith, that I would be leary of using entonox in this scenario because he has a compromised resp status, but that is just MHO because I do not admin that here in our ICU/ER.
    Awesome thread and that fabulous link. It is indeed remote.
  9. by   nrw350
    I agree, I would think he would need all the O2 he could get.

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