Guest guest Posted May 4, 2008 Report Share Posted May 4, 2008 Time on my hands today, so plenty of time to think up a scenario for your mutual torment. You are called to attend to a patient who has fallen. On arrival you find a 72 year old male lying on his living room floor. He is conscious and alert and complaining of severe pain to his left rib cage. He relates a fall when his little dog ran in front of him and he tripped, falling against the corner of his coffee table. Inspection reveals a white male of the stated age, lying in the left-lateral recumbent position, complaining of severe pain in his left side. He appears to weigh about 125 kg and is approximately 6'3 " tall. He is awake and answers questions appropriately. His airway is patent and he is breathing about 28 times a minute with shallow and painful inspirations. His pulse is 100 and mostly regular, but with occasional pauses in radial pulse. BP is 160/100. Patient states he takes atenalol and terazocin for blood pressure and that his normal BP is 130/72. He also states that he takes three drugs which he calls " VAD " for his multiple myeloma. He has a Duragesic patch on his chest. He also takes " a bunch of vitamins " every day. As your partner conducts a head to toe physical assessment, you continue to gather history. He relates that he has had multiple myeloma for the last 12 years and that he has undergone chemotherapy several years ago but his doctors have settled on the VAD treatment. He says he experiences constant back and hip pain, which is only partly relieved by his Duragesic patches. He also admits to taking a lot of Aleve without his doctor's knowledge. He says this is necessary for him to endure the constant pain. He denies drinking ETOH other than very rarely, and has never smoked. When your partner palpates the patient's left ribcage, he finds extreme point tenderness in the left midaxillary/anterior axillary line at ribs 5, 6, and 7. There is also marked ecchymosis over that region. Please answer the following questions: 1. What kind of disease is MM? 2. Is it likely to be a contributor to the patient's injury and if so, explain how and why. 2. What interventions will you do either prior to transport or during transport? 3. What concerns in patient transport would you have? 4. What electrolyte abnormalities, if any, would you suspect lab reports to show, and how would those abnormalities affect your pre-hospital care, if at all? 5. What similarities to MM might hyperparathyroidism produce? 6. Should you give any analgesia for the patient's pain, taking into consideration his Duragesic patch? 7. What are some co-existing conditions that a MM patient may have that the prehospital provider should be aware of? Have fun. GG ************** Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Well, drdugud, you have nailed it! Congratulations to, sir, or madame, as the case may be! Now, if I know who you are, and I think I do, I think you're a nurse/Paramedic. l Is that right? If you are a nurse, would you please write something about what your nursing education taught you that helped you figure this scenario out? Even if it didn't. Would you write about your thought processes in working through this scenario? What parts of nursing education helped with solving this puzzle. Are nurses better qualified to figuer it out than well trained paramedics? Part of this is to show folks how to work through a challenge like that and come up with the right answer. GG > > Just a start... > > 1. What kind of disease is MM? > > MM is a type of bone cancer that affects plasma cells in the bones. It > causes thinning of the bones. > > 2. Is it likely to be a contributor to the patient's injury and if so, > explain how and why. > > Sure. The bone density is reduced due to abnormal bone destruction. The bone > destruction rate is faster than the production rate. > > 2. What interventions will you do either prior to transport or during > transport? > > Standard stuff...V/S, O2, Monitor, IV, spinal restrictions, splint chest > wall if possible... > > Assess hydration status and give a generous amount of NS if the pt has s/s > of dehydration. > > Assess blood sugar. VAD treatment contains an extremely high dose (can't > remember exact amount) of dexamethasone. > > 3. What concerns in patient transport would you have? > > Oxygenation status as the pt doesn't want to expand his chest wall. > Spinal injuries > Dehydration > > 4. What electrolyte abnormalities, if any, would you suspect lab reports to > show, and how would those abnormalities affect your pre-hospital care, if at > > all? > > High serum calcium levels > Low phosphorus levels > Increase in BUN/creatinine and H & H if the pt is dehydrated > > Fluids for s/s of dehydration > > 5. What similarities to MM might hyperparathyroidism produce? > > High serum calcium levels and low phosphorus levels (Same as pts that > consume too many antacids) > > 6. Should you give any analgesia for the patient's pain, taking into > consideration his Duragesic patch? > > Perhaps in a lower dose. > > 7. What are some co-existing conditions that a MM patient may have that the > prehospital provider should be aware of? > > Heart disease, diabetes, dehydration, any s/s of infection, spinal > injuries.... > > > > > Time on my hands today, so plenty of time to think up a scenario for > > your > > mutual torment. > > > > You are called to attend to a patient who has fallen. On arrival you find > > a > > 72 year old male lying on his living room floor. He is conscious and alert > > > > and complaining of severe pain to his left rib cage. He relates a fall > > when > > his little dog ran in front of him and he tripped, falling against the > > corner > > of his coffee table. > > > > Inspection reveals a white male of the stated age, lying in the > > left-lateral > > recumbent position, complaining of severe pain in his left side. He > > appears > > to weigh about 125 kg and is approximately 6'3 " tall. He is awake and > > answers questions appropriately. His airway is patent and he is breathing > > about 28 > > times a minute with shallow and painful inspirations. His pulse is 100 and > > > > mostly regular, but with occasional pauses in radial pulse. BP is 160/100. > > > > Patient states he takes atenalol and terazocin for blood pressure and that > > > > his normal BP is 130/72. He also states that he takes three drugs which he > > > > calls " VAD " for his multiple myeloma. He has a Duragesic patch on his > > chest. > > He also takes " a bunch of vitamins " every day. > > > > As your partner conducts a head to toe physical assessment, you continue > > to > > gather history. He relates that he has had multiple myeloma for the last > > 12 > > years and that he has undergone chemotherapy several years ago but his > > doctors > > have settled on the VAD treatment. He says he experiences constant back > > and > > hip pain, which is only partly relieved by his Duragesic patches. He also > > admits to taking a lot of Aleve without his doctor's knowledge. He says > > this > > is necessary for him to endure the constant pain. He denies drinking ETOH > > other than very rarely, and has never smoked. > > > > When your partner palpates the patient's left ribcage, he finds extreme > > point > > tenderness in the left midaxillary/ tenderness in the left midaxillary/ > > and > > 7. There is also marked ecchymosis over that region. > > > > Please answer the following questions: > > > > 1. What kind of disease is MM? > > > > 2. Is it likely to be a contributor to the patient's injury and if so, > > explain how and why. > > > > 2. What interventions will you do either prior to transport or during > > transport? > > > > 3. What concerns in patient transport would you have? > > > > 4. What electrolyte abnormalities, if any, would you suspect lab reports > > to > > show, and how would those abnormalities affect your pre-hospital care, if > > at > > all? > > > > 5. What similarities to MM might hyperparathyroidism produce? > > > > 6. Should you give any analgesia for the patient's pain, taking into > > consideration his Duragesic patch? > > > > 7. What are some co-existing conditions that a MM patient may have that > > the > > prehospital provider should be aware of? > > > > Have fun. > > > > GG > > > > ************ * > > Wondering what's for Dinner Tonight? Get new twists on family > > favorites at AOL Food. > > > > (http://food.http://food.<wbhttp://food.http://food.<wbrhttp) > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Just a start... 1. What kind of disease is MM? MM is a type of bone cancer that affects plasma cells in the bones. It causes thinning of the bones. 2. Is it likely to be a contributor to the patient's injury and if so, explain how and why. Sure. The bone density is reduced due to abnormal bone destruction. The bone destruction rate is faster than the production rate. 2. What interventions will you do either prior to transport or during transport? Standard stuff...V/S, O2, Monitor, IV, spinal restrictions, splint chest wall if possible... Assess hydration status and give a generous amount of NS if the pt has s/s of dehydration. Assess blood sugar. VAD treatment contains an extremely high dose (can't remember exact amount) of dexamethasone. 3. What concerns in patient transport would you have? Oxygenation status as the pt doesn't want to expand his chest wall. Spinal injuries Dehydration 4. What electrolyte abnormalities, if any, would you suspect lab reports to show, and how would those abnormalities affect your pre-hospital care, if at all? High serum calcium levels Low phosphorus levels Increase in BUN/creatinine and H & H if the pt is dehydrated Fluids for s/s of dehydration 5. What similarities to MM might hyperparathyroidism produce? High serum calcium levels and low phosphorus levels (Same as pts that consume too many antacids) 6. Should you give any analgesia for the patient's pain, taking into consideration his Duragesic patch? Perhaps in a lower dose. 7. What are some co-existing conditions that a MM patient may have that the prehospital provider should be aware of? Heart disease, diabetes, dehydration, any s/s of infection, spinal injuries..... > Time on my hands today, so plenty of time to think up a scenario for > your > mutual torment. > > You are called to attend to a patient who has fallen. On arrival you find > a > 72 year old male lying on his living room floor. He is conscious and alert > > and complaining of severe pain to his left rib cage. He relates a fall > when > his little dog ran in front of him and he tripped, falling against the > corner > of his coffee table. > > Inspection reveals a white male of the stated age, lying in the > left-lateral > recumbent position, complaining of severe pain in his left side. He > appears > to weigh about 125 kg and is approximately 6'3 " tall. He is awake and > answers questions appropriately. His airway is patent and he is breathing > about 28 > times a minute with shallow and painful inspirations. His pulse is 100 and > > mostly regular, but with occasional pauses in radial pulse. BP is 160/100. > > Patient states he takes atenalol and terazocin for blood pressure and that > > his normal BP is 130/72. He also states that he takes three drugs which he > > calls " VAD " for his multiple myeloma. He has a Duragesic patch on his > chest. > He also takes " a bunch of vitamins " every day. > > As your partner conducts a head to toe physical assessment, you continue > to > gather history. He relates that he has had multiple myeloma for the last > 12 > years and that he has undergone chemotherapy several years ago but his > doctors > have settled on the VAD treatment. He says he experiences constant back > and > hip pain, which is only partly relieved by his Duragesic patches. He also > admits to taking a lot of Aleve without his doctor's knowledge. He says > this > is necessary for him to endure the constant pain. He denies drinking ETOH > other than very rarely, and has never smoked. > > When your partner palpates the patient's left ribcage, he finds extreme > point > tenderness in the left midaxillary/anterior axillary line at ribs 5, 6, > and > 7. There is also marked ecchymosis over that region. > > Please answer the following questions: > > 1. What kind of disease is MM? > > 2. Is it likely to be a contributor to the patient's injury and if so, > explain how and why. > > 2. What interventions will you do either prior to transport or during > transport? > > 3. What concerns in patient transport would you have? > > 4. What electrolyte abnormalities, if any, would you suspect lab reports > to > show, and how would those abnormalities affect your pre-hospital care, if > at > all? > > 5. What similarities to MM might hyperparathyroidism produce? > > 6. Should you give any analgesia for the patient's pain, taking into > consideration his Duragesic patch? > > 7. What are some co-existing conditions that a MM patient may have that > the > prehospital provider should be aware of? > > Have fun. > > GG > > ************** > Wondering what's for Dinner Tonight? Get new twists on family > favorites at AOL Food. > > (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Thanks, Gene....but I hope the scenario isn't over. I would like to see what others may add to this scenario. It is a fantastic scenario and illustrates the need for continued education beyond our basic school. It is easy for us to treat the rib fractures and skip the rest of the scenario, and sadly is accepted by far too many services and medics as an " ok " standard of care. I can't blame anyone if they only treat the rib fx, as that is what we are taught in school. I didn't realize that my signature came up at the very bottom of the page, instead of where I quit typing. Oops!! Neil White. You are correct, I am a a nurse/paramedic, or as I say, a paramedic that happens to hold a nursing license. Nursing school did help some. Going through each disease process and the associated s/s, lab values, and various other considerations was a great deal of help. I must say, however, that most of what I would consider to be the most beneficial " education " for this scenario was having a fantastic mentor at one point. Somewhere between emt, paramedic, and nursing I worked in a family practice office. The doc and the PA insisted I continue my education beyond what would normally be expected. If they had a strange case they would make/allow me to work up the patient on my own until I could solve the problem myself, then give me a great deal of feedback on where I went right or wrong. Paramedic school gave me a great foundation for emergency care and a skill set that I rarely see in nursing. Nursing school gave me a theoretical background and research background that I rarely (although not as rare as the above statement) see in a paramedic. It seems as though medic school was more of " This is CHF. This is the treatment " where nursing school went more into the specifics of a disease process and gave general guidelines for treatment. Thought process? Here goes.... 1. Basic assessment and treatment (V/S, O2, Monitor, IV, spinal restriction) 2. Detailed assessment including specific assessment for the disease process (bone fx, weakness, elevated blood sugar, hydration status) 3. Treatment based on physical findings. (Hydration status) 4. Treatment to manage the side effects of previous treatment (glucose) Let me know if you have other questions... Great scenario...Neil > > Well, drdugud, you have nailed it! Congratulations to, sir, or madame, > as the > case may be! > > Now, if I know who you are, and I think I do, I think you're a > nurse/Paramedic. l Is that right? > > If you are a nurse, would you please write something about what your > nursing > education taught you that helped you figure this scenario out? Even if it > didn't. Would you write about your thought processes in working through > this > scenario? > > What parts of nursing education helped with solving this puzzle. Are > nurses > better qualified to figuer it out than well trained paramedics? > > Part of this is to show folks how to work through a challenge like that > and > come up with the right answer. > > GG > In a message dated 5/5/08 3:14:02 AM, drdugud@...<drdugud%40gmail.com>writes: > > > > > Just a start... > > > > 1. What kind of disease is MM? > > > > MM is a type of bone cancer that affects plasma cells in the bones. It > > causes thinning of the bones. > > > > 2. Is it likely to be a contributor to the patient's injury and if so, > > explain how and why. > > > > Sure. The bone density is reduced due to abnormal bone destruction. The > bone > > destruction rate is faster than the production rate. > > > > 2. What interventions will you do either prior to transport or during > > transport? > > > > Standard stuff...V/S, O2, Monitor, IV, spinal restrictions, splint chest > > wall if possible... > > > > Assess hydration status and give a generous amount of NS if the pt has > s/s > > of dehydration. > > > > Assess blood sugar. VAD treatment contains an extremely high dose (can't > > remember exact amount) of dexamethasone. > > > > 3. What concerns in patient transport would you have? > > > > Oxygenation status as the pt doesn't want to expand his chest wall. > > Spinal injuries > > Dehydration > > > > 4. What electrolyte abnormalities, if any, would you suspect lab reports > to > > show, and how would those abnormalities affect your pre-hospital care, > if at > > > > all? > > > > High serum calcium levels > > Low phosphorus levels > > Increase in BUN/creatinine and H & H if the pt is dehydrated > > > > Fluids for s/s of dehydration > > > > 5. What similarities to MM might hyperparathyroidism produce? > > > > High serum calcium levels and low phosphorus levels (Same as pts that > > consume too many antacids) > > > > 6. Should you give any analgesia for the patient's pain, taking into > > consideration his Duragesic patch? > > > > Perhaps in a lower dose. > > > > 7. What are some co-existing conditions that a MM patient may have that > the > > prehospital provider should be aware of? > > > > Heart disease, diabetes, dehydration, any s/s of infection, spinal > > injuries.... > > > > > > > > > Time on my hands today, so plenty of time to think up a scenario for > > > your > > > mutual torment. > > > > > > You are called to attend to a patient who has fallen. On arrival you > find > > > a > > > 72 year old male lying on his living room floor. He is conscious and > alert > > > > > > and complaining of severe pain to his left rib cage. He relates a fall > > > when > > > his little dog ran in front of him and he tripped, falling against the > > > corner > > > of his coffee table. > > > > > > Inspection reveals a white male of the stated age, lying in the > > > left-lateral > > > recumbent position, complaining of severe pain in his left side. He > > > appears > > > to weigh about 125 kg and is approximately 6'3 " tall. He is awake and > > > answers questions appropriately. His airway is patent and he is > breathing > > > about 28 > > > times a minute with shallow and painful inspirations. His pulse is 100 > and > > > > > > mostly regular, but with occasional pauses in radial pulse. BP is > 160/100. > > > > > > Patient states he takes atenalol and terazocin for blood pressure and > that > > > > > > his normal BP is 130/72. He also states that he takes three drugs > which he > > > > > > calls " VAD " for his multiple myeloma. He has a Duragesic patch on his > > > chest. > > > He also takes " a bunch of vitamins " every day. > > > > > > As your partner conducts a head to toe physical assessment, you > continue > > > to > > > gather history. He relates that he has had multiple myeloma for the > last > > > 12 > > > years and that he has undergone chemotherapy several years ago but his > > > doctors > > > have settled on the VAD treatment. He says he experiences constant > back > > > and > > > hip pain, which is only partly relieved by his Duragesic patches. He > also > > > admits to taking a lot of Aleve without his doctor's knowledge. He > says > > > this > > > is necessary for him to endure the constant pain. He denies drinking > ETOH > > > other than very rarely, and has never smoked. > > > > > > When your partner palpates the patient's left ribcage, he finds > extreme > > > point > > > tenderness in the left midaxillary/ tenderness in the left > midaxillary/ > > > and > > > 7. There is also marked ecchymosis over that region. > > > > > > Please answer the following questions: > > > > > > 1. What kind of disease is MM? > > > > > > 2. Is it likely to be a contributor to the patient's injury and if so, > > > explain how and why. > > > > > > 2. What interventions will you do either prior to transport or during > > > transport? > > > > > > 3. What concerns in patient transport would you have? > > > > > > 4. What electrolyte abnormalities, if any, would you suspect lab > reports > > > to > > > show, and how would those abnormalities affect your pre-hospital care, > if > > > at > > > all? > > > > > > 5. What similarities to MM might hyperparathyroidism produce? > > > > > > 6. Should you give any analgesia for the patient's pain, taking into > > > consideration his Duragesic patch? > > > > > > 7. What are some co-existing conditions that a MM patient may have > that > > > the > > > prehospital provider should be aware of? > > > > > > Have fun. > > > > > > GG > > > > > > ************ * > > > Wondering what's for Dinner Tonight? Get new twists on family > > > favorites at AOL Food. > > > > > > (http://food.http://food.<wbhttp://food.http://food.<wbrhttp) > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 5, 2008 Report Share Posted May 5, 2008 Thanks, Neil. I thought that was you. Actually this scenario is one my paramedic students are working on. We just did hematology, and I wanted to see how they will do. We'll see if any of them take the hypercalcemia into account and what lurking dangers they come up with because of that. GG > > Thanks, Gene....but I hope the scenario isn't over. I would like to see what > others may add to this scenario. It is a fantastic scenario and illustrates > the need for continued education beyond our basic school. It is easy for us > to treat the rib fractures and skip the rest of the scenario, and sadly is > accepted by far too many services and medics as an " ok " standard of care. I > can't blame anyone if they only treat the rib fx, as that is what we are > taught in school. > > I didn't realize that my signature came up at the very bottom of the page, > instead of where I quit typing. Oops!! Neil White. > > You are correct, I am a a nurse/paramedic, or as I say, a paramedic that > happens to hold a nursing license. > > Nursing school did help some. Going through each disease process and the > associated s/s, lab values, and various other considerations was a great > deal of help. I must say, however, that most of what I would consider to be > the most beneficial " education " for this scenario was having a fantastic > mentor at one point. Somewhere between emt, paramedic, and nursing I worked > in a family practice office. The doc and the PA insisted I continue my > education beyond what would normally be expected. If they had a strange case > they would make/allow me to work up the patient on my own until I could > solve the problem myself, then give me a great deal of feedback on where I > went right or wrong. > > Paramedic school gave me a great foundation for emergency care and a skill > set that I rarely see in nursing. > Nursing school gave me a theoretical background and research background that > I rarely (although not as rare as the above statement) see in a paramedic. > > It seems as though medic school was more of " This is CHF. This is the > treatment " where nursing school went more into the specifics of a disease > process and gave general guidelines for treatment. > > Thought process? Here goes.... > > 1. Basic assessment and treatment (V/S, O2, Monitor, IV, spinal restriction) > 2. Detailed assessment including specific assessment for the disease process > (bone fx, weakness, elevated blood sugar, hydration status) > 3. Treatment based on physical findings. (Hydration status) > 4. Treatment to manage the side effects of previous treatment (glucose) > > Let me know if you have other questions... > > Great scenario...Neil > > > > > > Well, drdugud, you have nailed it! Congratulations to, sir, or madame, > > as the > > case may be! > > > > Now, if I know who you are, and I think I do, I think you're a > > nurse/Paramedic. l Is that right? > > > > If you are a nurse, would you please write something about what your > > nursing > > education taught you that helped you figure this scenario out? Even if it > > didn't. Would you write about your thought processes in working through > > this > > scenario? > > > > What parts of nursing education helped with solving this puzzle. Are > > nurses > > better qualified to figuer it out than well trained paramedics? > > > > Part of this is to show folks how to work through a challenge like that > > and > > come up with the right answer. > > > > GG > > In a message dated 5/5/08 3:14:02 AM, drdugud@...< > drdugud%40gmail.drd>writes: > > > > > > > > Just a start... > > > > > > 1. What kind of disease is MM? > > > > > > MM is a type of bone cancer that affects plasma cells in the bones. It > > > causes thinning of the bones. > > > > > > 2. Is it likely to be a contributor to the patient's injury and if so, > > > explain how and why. > > > > > > Sure. The bone density is reduced due to abnormal bone destruction. The > > bone > > > destruction rate is faster than the production rate. > > > > > > 2. What interventions will you do either prior to transport or during > > > transport? > > > > > > Standard stuff...V/S, O2, Monitor, IV, spinal restrictions, splint chest > > > wall if possible... > > > > > > Assess hydration status and give a generous amount of NS if the pt has > > s/s > > > of dehydration. > > > > > > Assess blood sugar. VAD treatment contains an extremely high dose (can't > > > remember exact amount) of dexamethasone. > > > > > > 3. What concerns in patient transport would you have? > > > > > > Oxygenation status as the pt doesn't want to expand his chest wall. > > > Spinal injuries > > > Dehydration > > > > > > 4. What electrolyte abnormalities, if any, would you suspect lab reports > > to > > > show, and how would those abnormalities affect your pre-hospital care, > > if at > > > > > > all? > > > > > > High serum calcium levels > > > Low phosphorus levels > > > Increase in BUN/creatinine and H & H if the pt is dehydrated > > > > > > Fluids for s/s of dehydration > > > > > > 5. What similarities to MM might hyperparathyroidism produce? > > > > > > High serum calcium levels and low phosphorus levels (Same as pts that > > > consume too many antacids) > > > > > > 6. Should you give any analgesia for the patient's pain, taking into > > > consideration his Duragesic patch? > > > > > > Perhaps in a lower dose. > > > > > > 7. What are some co-existing conditions that a MM patient may have that > > the > > > prehospital provider should be aware of? > > > > > > Heart disease, diabetes, dehydration, any s/s of infection, spinal > > > injuries.... > > > > > > > > > > > > > Time on my hands today, so plenty of time to think up a scenario for > > > > your > > > > mutual torment. > > > > > > > > You are called to attend to a patient who has fallen. On arrival you > > find > > > > a > > > > 72 year old male lying on his living room floor. He is conscious and > > alert > > > > > > > > and complaining of severe pain to his left rib cage. He relates a fall > > > > when > > > > his little dog ran in front of him and he tripped, falling against the > > > > corner > > > > of his coffee table. > > > > > > > > Inspection reveals a white male of the stated age, lying in the > > > > left-lateral > > > > recumbent position, complaining of severe pain in his left side. He > > > > appears > > > > to weigh about 125 kg and is approximately 6'3 " tall. He is awake and > > > > answers questions appropriately. His airway is patent and he is > > breathing > > > > about 28 > > > > times a minute with shallow and painful inspirations. His pulse is 100 > > and > > > > > > > > mostly regular, but with occasional pauses in radial pulse. BP is > > 160/100. > > > > > > > > Patient states he takes atenalol and terazocin for blood pressure and > > that > > > > > > > > his normal BP is 130/72. He also states that he takes three drugs > > which he > > > > > > > > calls " VAD " for his multiple myeloma. He has a Duragesic patch on his > > > > chest. > > > > He also takes " a bunch of vitamins " every day. > > > > > > > > As your partner conducts a head to toe physical assessment, you > > continue > > > > to > > > > gather history. He relates that he has had multiple myeloma for the > > last > > > > 12 > > > > years and that he has undergone chemotherapy several years ago but his > > > > doctors > > > > have settled on the VAD treatment. He says he experiences constant > > back > > > > and > > > > hip pain, which is only partly relieved by his Duragesic patches. He > > also > > > > admits to taking a lot of Aleve without his doctor's knowledge. He > > says > > > > this > > > > is necessary for him to endure the constant pain. He denies drinking > > ETOH > > > > other than very rarely, and has never smoked. > > > > > > > > When your partner palpates the patient's left ribcage, he finds > > extreme > > > > point > > > > tenderness in the left midaxillary/ tenderness in the left > > midaxillary/ > > > > and > > > > 7. There is also marked ecchymosis over that region. > > > > > > > > Please answer the following questions: > > > > > > > > 1. What kind of disease is MM? > > > > > > > > 2. Is it likely to be a contributor to the patient's injury and if so, > > > > explain how and why. > > > > > > > > 2. What interventions will you do either prior to transport or during > > > > transport? > > > > > > > > 3. What concerns in patient transport would you have? > > > > > > > > 4. What electrolyte abnormalities, if any, would you suspect lab > > reports > > > > to > > > > show, and how would those abnormalities affect your pre-hospital care, > > if > > > > at > > > > all? > > > > > > > > 5. What similarities to MM might hyperparathyroidism produce? > > > > > > > > 6. Should you give any analgesia for the patient's pain, taking into > > > > consideration his Duragesic patch? > > > > > > > > 7. What are some co-existing conditions that a MM patient may have > > that > > > > the > > > > prehospital provider should be aware of? > > > > > > > > Have fun. > > > > > > > > GG > > > > > > > > ************ * > > > > Wondering what's for Dinner Tonight? Get new twists on family > > > > favorites at AOL Food. > > > > > > > > (http://food.http://food.<wbhttp://food.wbhttp://foo<wbrhttp) > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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