PLEASE NOTE: if a question is personal to you or is a secret than may answer may not be perfect. i only answer questions in general and i will also give advise on things if nessacary, think of me as a second opinion
Actually, I subliminally pwned that person too, and so did you. The impersonation fell apart as soon as the impersonator showed no culinary knowledge with the spicy pork.
Okay, I think this thread has been flogged enough, so I'll put it out of its misery unless it is miraculously revived.
But I'm not interested in doing that, so how about I ask something that I know can't be found on a Google search...and since I can't quote my papers, I'll just...make up my own question!
Ms. Braithwhite is a 77 year-old retired receptionist with a history of myocardial infarction two years previously, longstanding type II diabetes controlled with lantus mane and novorapid td, and asthma managed with prn ventolin and daily spireva. She presents to the ED with a history of sudden onset of breathlessness. When you see her, she is using her accessory muscles of breathing, has a productive, pink frothy cough and has blue fingers and lips. Her pulse is irregularly irregular. She has significant swelling of both ankles and sacral oedema.
What is the most appropriate NEXT course of action?
1) Administer 4 units of novorapid. 2) Sit the patient upright. 3) Fluid resuscitate with IV infusion of normal saline. 4) Record an ECG. 5) Intubate the patient with an endotracheal.
If you can answer this question correctly I'll keep the thread open...lol no I'm not that slack. Whether or not I close the thread will be entirely dependent on whether it gets back on-topic and performing as intended.
Heheheeee...not bad reasoning but wrong answer. You would consider endotracheal tube if:
* Patient goes into respiratory arrest (at which the other thing you would do simultaeneously is ask a nurse to dial 444 and call a code blue). But this patient is still breathing.
* Patient is about to go into silent asthma, which may be the case here (as I implied in the history) but the presentation is not as strongly consistent with acute asthma attack as it is...something else. You may wish to intubate sooner rather than later in an asthma attack because a blocked trachea tends to make intubation rather difficult, leaving you with only one option: a tracheotomy!
1. If the patient is diabetic and is suffering from a 'whatsitcalled' then the four units of novorapid would be good to prevent this from happening.
2. Sitting the patient upright would possibly help remove any mucus from the trachea unless it is too congealed.
4. Because the patient has a bad pulse so may be having heart difficulties, so an ECG would be a good course of action to see if there is anything wrong, howver by laying the patient down to do this it may cause more problems if mucus from the lungs flows up the trachea.
3. Wouldn't that be squirting salt water down their throat?
NO MORE GUESSES! Give the other members a chance to respond. Besides noobkill is supposed to be answering this but heck, whatever.
But I can tell you, out of your thoughts...
Your reasoning for 2. is incorrect. 3...IV means intravenous, meaning inserting a cannula into the patient's vein and running the bag and lines. Your reasoning for 4 is not 100% but pretty close!
longstanding type II diabetes controlled with lantus mane and novorapid td
it is already controlled, giving her more will kill her from low blood pressure (grandma died this way)
2) Sit the patient upright.
best course of action right away.
3) Fluid resuscitate with IV infusion of normal saline.
because of this "She has significant swelling of both ankles and sacral oedema." so no.
4) Record an ECG.
Yes, because trouble breathing, blue fingers ect, pink frothy cough. Is a sure sign of heart failure, this ECG is used to tell if the patient has another acute myocardial infarction. This is what you do second.
5) Intubate the patient with an endotracheal.
last course of action is to intubate the patient. Because her breathing could stop any minute.
Trick question strop. Kakewalk (thats right kake) for me.
