Patient's Elevated Airway Pressure Puzzles Providers

An ALS crew is dispatched to the scene of a patient reported to have altered mental status and difficulty breathing. Upon arrival, you and your partner find a middle-age woman lying on the floor in the care of first responders with visibly shallow respirations.
According to the patient’s family, she was in her normal state of health and sitting in her recliner when she suddenly raised her hands into the air and began grabbing at both sides of her head. She then fell forward and was assisted to the ground by family.
Family members describe grunting respirations that began shortly thereafter and no change in her mental status from the time of the 9-1-1 call until the arrival of the paramedics. She reportedly has no medical problems, takes no medications and hasn’t recently suffered any injuries.
In your initial assessment, you notice that the patient withdraws from pain, but is otherwise unresponsive (Glasgow coma scale of 6); has pale and diaphoretic skin; shallow respirations without any abnormal lung sounds; left-sided flaccidity (upper and lower extremities); and no other significant physical findings.
Your partner tells you that the patient’s initial vital signs include a heart rate of 88, blood pressure of 152/92 mmHg, oxygen saturation of 42%, and shallow respirations at 36 breaths per minute.
Oxygen is immediately applied via non-rebreather mask and two peripheral IVs are established. The patient’s blood glucose is measured and found to be 153 mg/dL.
The patient...

Source: JEMS Patient Care - November 29, 2018 Category: Emergency Medicine Authors: John Freese, MD Tags: Airway & Respiratory Exclusive Articles Source Type: news