EMS World

AUG 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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ISSUE FOCUS: ADVANCED CARE 32 AUGUST 2018 | EMSWORLD.com I magine you and your partner are dis- patched to a low-priority "sick person" call. It sounds like any of a dozen others going on in your city at any given time: an elderly female who "doesn't feel well" with no priority symptoms. Your communications center advises the call has been pending for about 20 minutes, and you estimate your response will take 10 more. You arrive at a senior apartment com- plex and take the elevator to the third floor. You knock on the door, and the patient's husband greets you with a wor- ried look. "My wife isn't well," he says. Your patient is a female in her 60s who is sitting upright but slumped over in a recliner. She is pale, diaphoretic, and responds only to deep pain. Recognizing how quickly the situa- tion has escalated, you and your partner immediately take the patient's vital signs and place her on a cardiac monitor. She is in sinus bradycardia at a rate of 46 and has a blood pressure of 64/40, a respi- rator y rate of 10, and a room-air ox ygen saturation of 88%. The husband is an extremely poor his- torian and unable to provide much mean- ingful information about the woman's medical histor y. Undiff erentiated Shock This case is not unlike thousands para- medics respond to across the countr y ever y day. Absent a thorough his tor y, what tops the list of your dif ferential diagnoses for this patient? Is she in septic shock? Cardiogenic shock? Does she have a pericardial effusion leading to tampon- ade? Despite being competent clinicians skilled in the ar ts of histor y-taking and the physical exam, it remains difficult for By Stephanie Louka, MD, AEMT, and Thomas Hudson, NRP, CCP-C DIFFERENTIATING SHOCK Good care requires identifying the cause of a patient's shock—ultrasound can help

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