What's your diagnosis? - page 3

OK, 56 year old woman presents with weakness, diaphoresis, nausea, diarrhea, and Dyspnea at rest. BP 140/80, pulse thready 80, RR 28, lungs clear, temp 98. Onset of symptoms 20 minutes ago. History,... Read More

  1. by   EMTPTORN
    yes aussienurse!! very good thinking...THAT IS CRITICAL THINKING!!!

    hoolahan....here (all over florida) there is no such thing as a BLS truck unlees it is strictly for BLS transfers.

    FL state requirement all EMT-P's have ACLS...EMT's do not need ACLS (as they are not allowed to do anything advanced)

    Actualy, our Medical Director who does our training and puts out our protocols mentions atypical presentation for MI and ladies....
  2. by   Aussienurse2
    Thankyou, thankyou,
    was just a thought, we had a patient present at A&E with the same symptoms, turned out she'd eaten an apple straight from her neighbours tree, he'd sprayed the week before and she didn't wash it before eating it.
  3. by   RNforLongTime
    So Hoolahan,

    Keep us posted with how things turn out! I too would have to say probable MI. Let us know!
  4. by   hoolahan
    Well, Nadine called me today. Her enzyme level was 1.6, she has no idea what that is, so I am assuming it was troponin, ekg remains abnormal, she is scheduled for a cardiac cath tomorrow. I told her, whatever you do, don't let Dr. R touch you. She told me she asked who was doing the cath, and told the doc a nurse told her not to let him touch her! He told her he no longer works there. (Thank God!)

    I also found out her father had a massive MI in his 50's, and stroked out shortly after that, and was gorked essentially for years. Her mother had a huge MI in her 50's, and 2 brothers died from MI in their 50's. So her history is against her.

    She cried today, told me their financial status is really shaky, and she really hopes she can make the July craft show, b/c they need the money. Her husband had to do the last show w/o her, so poor thing didn't have anyone in the hospital. But, according to her, she said, I am OK with that, I don't want anyone here, when I am down, I want to be alone, not be ON for everyone. Her son found out, and is hurt that they didn't tell him sooner. Sigh, give mom a break, huh?

    I have been doing some reading on line, and have found several cases w borderline enzymes which turned out to be MI, one in particular, the pt had a 90% mid-circumflex lesion.

    I'll let you know what the cath shows.

    Meanwhile just saw grandmom, d/c from the hospital yesterday, she was all betwixed w her meds. Hospital d/c instructions said cardizem and warfarin, pharmacy said diltiazem and coumadin. Coumadin said "Take as directed" Direction from d/c instruction sheet were the same. The directions were written in MD's hand like this 1 1/2 tabs MWF 1 tab TTSS. She had NO idea MWF meant monday wed friday. She was soooo upset, I had to give her a 1/2 xanax to calm her down. I filled her mediplanner and said trust me, I did it right. Don't worry for now what to take when, just follow the boxes, it is one with day of week and even times on it. I assured her she will get it eventually, and until she does, I will be there for her. She was so angry and frustrated b/c she didn't understand WHY the pharm would put take as directed and not say what the directions are on the label. It made her feel stupid, and she is not stupid. I tried to explain to her it depends on labs, but she was in such a state that no learning was going to happen. Poor thing. I took her shopping to take her mind off it, after the xanax. Seems like I am doing a lot of cardiac consults lately!
  5. by   shygirl
    We just had a woman in the nursing home that presented with many of these symptoms and her dx. was....bowel obstruction!.
    I can't believe they took the O2 off, how lame is that?
  6. by   live4today
    Originally posted by gilda
    We just had a woman in the nursing home that presented with many of these symptoms and her dx. was....bowel obstruction!.
    I can't believe they took the O2 off, how lame is that?
    Hi gilda...My very first reaction to her symptoms was bowel obstruction...vagal nerve interference...I have that...only I couldn't explain the symptom of "Dyspnea at rest".

    Several times a year, I somehow manage to have a terrible vagal nerve interference with my bowels causing these very symptoms. I do have DYSPNEA, but only DURING the episode. I think I have some serious bowel problems, but no doctor seems to want to address them as yet. One doctor told me that he had a few soldiers discharged from the Army because of this very thing...so maybe they don't want to deal with this type of issue. I would think giving the patient something to calm the intestines, smooth the stool BEFORE exit, and relax the vagus nerve would go along way in helping. I plan on pursuing this avenue regarding myself come my next doctor appointment because when those vagal episodes happen to me, it is very scary. Sometimes, I think I am going to pass out and die right by the toilet where hubby will find me on the bathroom floor.
  7. by   CEN35
    margaret........ for us 1.6 is +

    our norm is 0-1.5, and if it was 1.6, that's a great thing. the higher the tropnin, the more damage there is........ so i think she is ahead now, if that's the peak.

    hope everything works out!

    me
  8. by   shygirl
    Cheerfuldoer,,

    I don't want to be personal, but why don't you try a stool softner
    qd. and do you drink enough H2O?
    Gilda
  9. by   neat nurse
    MY first thought was ?MI But having seen something similar in my area I thought maybe bowel obstruction, diarrhea being over flow. Anyway good luck and I hope she's improved. neatnurse:
  10. by   live4today
    Originally posted by gilda
    Cheerfuldoer,,

    I don't want to be personal, but why don't you try a stool softner
    qd. and do you drink enough H2O?
    Gilda
    Ahhhh...go ahead Gilda...get personal on me. :chuckle

    Yes, I do drink lots and lots of water. Water is my favorite drink! Always has been, always will be as I don't care for sweet or carbonated beverages much. I may have an occasional few sips of Pepsi or Ice Tea or Lemonade when hubby and I go out to dinner, but for the most part, I promote drinking water like Britney Spears promotes drinking Pepsi. :chuckle Also, when I'm having that vagal response with the intestinal tract, I'm NOT constipated but have a serious case of Diarrhea...I'm NEVER straining to have a stool. One does NOT have to have a problem with constipation to have this vagal thingy that I and a lot of other people have...according to my doctor. Thanks for the suggestions though.
  11. by   Peeps Mcarthur
    So it's just a loss of negative feedback mechanism?
  12. by   Peeps Mcarthur
    I mean for the response of the vagal stimulation.

    Sorry to hear of it.

    Don't feel pressured to respond, I'm just curiouse.
  13. by   hoolahan
    Well, thanks for sharing your bowel problem Renee, usually I tell my friends that is TMI or Too Much Information for me to know about them, but what you have is interesting, I would also have assumed it was from constipation.

    Things that make you go Hhhmmmm....

    Heard from my neighbor, coronaries are clean. Sent home w/o NTG patch she wore in the hospital. Now they are going to check her carotids. Maybe she did the vagal thing like you Renee?? She doesn't have a bowel obstruction, that was r/o. she doesn't have thyroid issue, that was r/o. But she is going to follow up w doc in 2 weeks, so we'll see where it goes from there. All in all she was glad I made her go to the hospital, she said if I hadn't, she would not have gone. She also said she is greatly relieved to learn that her coronaries are clean, with her family history, she is very very worried about it. Only new med is a baby asa a day. She looks good and is happy to be home.

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