Medic 1 Observation

The nurse found Mrs Smith to be tachypnoeic, her respirations were recorded as 24 breaths per minute it was observed as being fast and it appeared that her accessory muscles were being used. Mrs Smith’s pallor also appeared flushed and her saturations were documented as 93%. The nurse used the stethoscope to check for wheeze the patient’s lungs were clear and chest rise was symmetrical. Mrs Smith was commenced on 100% oxygen through a non-rebreathe mask, oxygen as an intervention is necessary as Creed & Spiers (2010) highlight ‘metabolic demand for oxygen throughout the body is hugely increased by sepsis and is essential to ensure the supply of oxygen is maximized’ .The nurse monitored the patient closely because in her confused state the patient may try to remove the oxygen mask.

She has an ostomy. She was fresh from surgery yesterday, so they gave her pain meds to manage the pain. When I first walked into the room, I learned that she was making snore-liking sounds when she was breathing. From what I have learned, it is called rhonchi. She had many secretions going on. What I was concerned of was how much oxygen she was getting in. I looked at her last vital signs and found that she was had a 92 percent o2 sat level. I was also concerned about her aspirating. Therefore, we had to make sure her HOB 30-45 degrees. I made sure the side rails were up x3 because of fall precaution. She was comfortable most of the time but I taught her but the risk for pressure sores. She understood the need turn frequently to prevent pressure sores. Later I looked in her labs and found that her hemoglobin at 7.1. She was a candidate for blood transfusion. The nurse was teaching me how blood transfusions are done. Before they give her blood, they have to get her last vital signs. We were consistently checking her vitals as we were giving her a blood transfusion. After giving her blood, we had to monitor her and her vital signs for any transfusion reaction. The symptoms of transfusion reaction is shortness of breath and depressed vital signs. Later we found that her oxygen level was at a 93 percent. Afterwards, I looked into her chart and found that he had an XRAY done, which revealed

The Author will firstly discuss why the ‘Vital Signs’ would be; followed by both the immediate treatment that should be given and the intervention needed from more advanced medical personnel.

The incident happened on Nov 21st, 2017. The patient has sleep apnea and a health history of chronic bronchitis (no episode in recent 2 years). Her respiration rate was 16 and all lung fields were clear upon auscultation. After I took the patient’s vital signs, I noticed that her oxygen saturation was low (83%). Then, I notified the nurse and asked the patient to do take some deep breath. After that, we put her on 2L of oxygen and her oxygen saturation went up to above 90s. However, the patient had a bladder control problem (was incontinent), so I took the oxygen off because she went to the toilet for around 4-5 times in an hour. However, I forgot to monitor her O2 saturation right away. Instead, I checked her oxygen saturation after she finished her dinner, and it dropped to 86%. The instructor showed me how deep breathing exercise can help the patient increase her oxygen level quickly. I notified the nurse and we put the patient on 2L of oxygen, but again I forgot to check her oxygen saturation right away. Instead, I checked her oxygen around 7pm later.

The first encounter was a patient, experiencing shortness of breath (SOB). I first wanted to assess if the situation was emergent. When I walked in the room the patient was able to speak clearly, his was not cyanotic, he did not appear to be in respiratory distress or in need of immediate intervention. My goal form there was to figure out the cause of the SOB. He had told me he had been experiencing SOB for three days, on and off, and that it had happened in the past. He had no history of chronic respiratory illness. We talked about his general medical history, which included hypertension (HTN). He is on Lasix, which he does not take as prescribed due to frequently urination. Teaching was done on the

On September 4, 2016 at approximately 0210 hours, Security Officers Ariel Weiland, Collins McCoy and Steven Evans responded to multiple code (73) Panic/Duress Alarm at the EMS bay area. Upon arrival, we were informed by medical staff y that security was needed in room ED #35. Security went in the room and observed numerous medical staff trying to control combative patient, Marten Sommer (DOB: FIN- 10/15/1993-86129014) on the stretcher. Patient Sommer was yelling, highly intoxicated, acting in a belligerent manner and attempted to get out bed. The patient attempted to hit E.D. Doctor Peter Alamia at which time Security Officers Collins took control of his lower limbs while Officers Weiland and Evans control his upper body.

At today’s visit he is accompanied by his daughter. The patient is awake, alert but unable to express his needs. I am her to follow up per the family request due to the patient having an elevated temperature. The daughter reports that on Sunday the patient had a temperature of 99. She gave him Tylenol via his PEG and his elevated temperature resolved. She reports that he has a chronic cough, which has not worsened. The patient has pressure ulcer to his buttock which is care for by his family. The patient is unable to clear his secretion; the family suctions him throughout the day. The patient is at risk for aspiration pneumonia and increased skin breakdown due to his decrease

Sitting at triage, this particular night was busy but not chaotic when a father and son approached to be assessed; pt had been unwell with his asthma for the day and had been following his asthma plan but was not responding to the treatment dad stated pt has unstable asthma and has one presentation to intensive care unit pt was alert orientated talking in full sentences but had wide spread wheeze bilaterally saturations 98% room air mild work of breathing noted. Started treatment in triage room ventolin (five milligrams bronchodilator that relaxes smooth muscles) and atrovent (five micrograms bronchodilator for bronchospasm) nebulizer given with good effect patient was given a category 3 to be seen in half an hour.

On Thursday, February 25, 2016 at 9:17pm Traci Carreras in Unit # 8-2D called 911 for an ambulance. RA Gayle asked T. Carreras “Who is the emergency for?” She stated “Her husband Joseph Carreras has a fever.” The family came downstairs to the lobby and waited for the ambulance to arrive. RA Adme observed Mr. Carreras, NYPD Badge # 2108 Devito and #9636 Bhuiyan arrived 9:38pm at the facility. NYPD spoke with Mr. Carreras, and then EMT Badge # 2741 Lewis and #2785 Marcellus arrived to the facility. Emt came off site at 9:47pm the family of Unit # 8-2D was taken to Brookdale Hospital. Shortly after, NYPD came off site at

Subjective: Patient T.B. is a 74 year old female African American presented to the Emergency Room complaining of chest pain which began at home. She stated that she was just relaxing at home and she developed chest pain. She called EMS. The chest pain did resolve before she reached the ER, but recurred again in the ER, each episode lasting for at least half an hour long. Chest pain was described as heavy pressure and she pointed at her central chest region. She denied radiating pain to the neck, jaw, back, shoulders, or arms. She gave her pain a rating of eight out of ten. She was slightly short of breath and oxygen two liters per minute via nasal cannula was applied. She was given

On 10/19/2016 at approximately 0830 hrs. I was dispatched to E St. between 11th and 12 th St for an injury traffic collision. I was requested by California Department of Forestry and Fire protection (CDF) to respond code three to their location. I then responded code three with my overhead lights and siren activated. I arrived on scene and saw that Riggs Ambulance service and CDF were already on scene administering first aid to a male in the roadway

A 10 year old boy presents with his mother to the Emergency Room in respiratory distress. The mother reports he developed nasal congestion and sore throat 24 hours prior, then a cough a few hours previously. Over the past 2 hours he has complained of chest pain and has been breathing rapidly. His mother administered a unit dose of albuterol via the nebulizer and then a second dose 5 minutes later. He showed no signs of improvement. She reports he has had two similar episodes in the past year. Your examination reveals an afebrile child with a respiratory rate of 40 breaths/minute, oxygen saturation of 88% by pulse oximetry, and a heart rate of 130 beats/min. You note that his radial pulse becomes weak in amplitude with inspiration. His blood pressure is normal but his capillary refill is sluggish at 6 seconds. He appears drowsy and is using accessory chest muscles to breathe. You hear faint inspiratory wheezes and no breath sounds during expiration.

The third patient that came to the clinic to be seen, came with his girlfriend with complain of shortness of breath. The patient was a 22 year old African American with a history of chronic asthma from childhood. On examination, I noted that he was wheezing and had a

Listening to his lungs went well, I heard crackles from one of his lungs, but my heart was pounding when his vital monitor started to beep on him as I put the oximeter on his finger to check his O2 sat. The screen was red and blinking, and then the number I got was 78 %. Although his O2 sat number went up 92~93%, the machine was still beeping, along with that my heart was pounding. As I was startled by monitor’s beeping, the respiratory therapist told me “Don’t look at the number; look at your patient and listen to him,” then I took my breath and pondered what I missed there. My patient was confused a little but he didn’t show neither cyanosis nor pallor on his skin, and his capillary refill was less than 3 seconds. Most of all, he was talking to me about his breakfast. I was deceived by machine, ignoring my assessment findings, resulting in almost getting wrong data. I did see and hear my patient, but neither look at nor listen to him carefully. I couldn’t use my intuition which I thought I was good

On April 05, 2016 at approximately 1518 hours, I was dispatch to 2004 Pine Street in reference to a death investigation. Upon my arrival, I met with Detective Campbell who was the lead Investigator at the scene. Detective Campbell stated that the victim neighbors reported a strong smell coming from the victim’s (Cortiz Lazarz) residence. The neighbors called 911 and Officer Volk was the first responded officer on scene. Defective Campbell and officer Volk stated that the victim located on the living room floor, fazing the south from the residence. Detective Campbell requested I process the scene for evidence and documentation.