I sent a pt to the ER yesterday from out pt rehab.I was 1 of 2 nurses.No Dr was present as is the norm in non telemetry classes in this type of setting.
The patient has,no major cardiac history other than HTN, hx of lap -chole ,obese but no other health issue begins decompensating. She had eaten 3hrs prior and on arrival to rehab is her usual bubbly self with BP128/82,RSR, consistent with baseline. IO min after exercise she felt weak , nauseous,diaphoretic,,numbness to hands,denies chest pain but has slight pain LUQ,repeating near syncope episodes and intermittent confusion
.BP 240/128 ,RSR 60,.No SOB but RR about 18.. Sat on RA 88% , the 4L NC bumps her to 95%.Pt is 350 lbs ,has hx of panic attacks.Exercises usually 3-4x a week for 60 min minimum x 3yrs. She is fearful but not panicking.
My first thoughts,stroke,low sugar/dry ,MI in that order. CS 102. FAST stroke protocol negative. ASA given.12 lead,no ST changes.BP now 218/108 RSR 71 RR 17.Upgraded to NRB. BP tapered down to 160/92 56 SB .EMS arrived, pt transferred to the ED.CS in ambulance 107,RSR 60 ,136/72,transient confusion,sluggish,co operative
The center was close to our closing time.We do not usually go with pt to ER but we were concerned that she may have panic attack en route and also that this history,weight, or transient confusion may effect her diagnosis.
So nurses ,with the information provided I am wondering....What do you think the pt issue was?,How would you have treated her? (please bare in mind that this is out pt with only 2 staff present )What do you think was the initial diagnosis by MD in the ED? Thanks ahead of time for your input.
