SOB Case scenario

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45 YOF with PHX of Stroke, Cocaine abuse presented to clinic requesting a med refill. The patient was triaged first and then placed in WR for the next available room as the patient was stable at the time of triage.

VS at triage : BP 146/94, HR 90, Temp 36.4 °C, RR 20, SpO2 100 % on RA.

 Apparently, the patient started deeply breathing while eating in WR and stating, "I can’t breathe".

DO NOT underestimate! Always remember to response quick and anticipate the worst-case scenario unless proven otherwise. 

 Is this patient choking on her food? Hypoxic? MI? High on substance? Abnormal blood sugar?

Most importantly, you have to make sure to determine whether the patient is choking on her food or not. The status can only be determined by asking the patient a question "Are you choking?" If the patient indicates “yes” by nodding her head without speaking, then she has an airway obstruction, and you have to attempt Valsalva maneuver.

 Who can be the first response to this situation? This patient could have a fall risk. Any staff member can provide the response by helping keep the patient company until a nurse or tech arrives at the scene to prevent her fall and injury in WR.

 What is your role as a nurse or tech in this situation? The role of a nurse is to stay with а patient and prevent her from falling. One should call for help and ask for a wheelchair or bed (bed is preferable). Place patient on bed/wheelchair and take her to the next available room as per charge RN.

 What is your first intervention in a room? Call for attendance. Place the patient on cardiac monitor (If available), check VS, order EKG, and POC Glucose (> 35 yo with Hx of DM c/o SOB)

 Who should you call to assist you with this patient?  Pod nurses, а tech, and a provider (This patient might be the sickest pt in your Pod).   

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