🚀 go-pugleaf

This is being posted to both the Emergency services and Student Nurse
groups, so those of you who don't normally ride ambulances, please
think like you are on some outside of the hospital training.....

You are called to the apartment of a 25 year old white female who has
recently delivered a baby without problems. Pregnancy was normal, and
both mother and child came home in three days. Mother has been breast
feeding 10 minutes each side every 2 hours since discharge 2 weeks
ago. You were called by the visiting nurse from the local Health
Department who was checking on the new mother. The mother is somewhat
distraught at the time of your arrival.

Mother is complaining about right upper quadrant pain which has
increased over the last week. She has also noted easy bruising. Her
appetite is still down and mother has lost about 15 pounds since
birth. She complains of puffiness in the face today.

Vital signs: B/P 130/86 left, 128/78 right, pulse 100, temp 100.4,
resp 20 and shallow- she states it hurts to breath.

Primary and secondary assessment are completed, indicating mild facial
swelling, Pupils are equal round and reactive to light. Eyes track
well and together. Neck showes no nodes, masses, venous distension or
nuchal signs.

Lungs are clear with good air movement. Heart sounds are moderately
hyper dynamic, but regular rate and rythem with a grade II/VI murmur
heard best at the lower left sternal border.

Abdomen is parous, soft, with reduced muscle tone. There is diffuse
tenderness most impressively over the right upper quadrant and the
supra pubic area. OB pad is in place, and shows a scant amount of
bloody discharge.

Extremities show no clubbing, cyanosis or edema. 

Skin shows no jaundice, but multple small bruises are noted.

Question 1: What other information do you want to get from the mother
or the visiting nurse?

Question 2: How fast do you want to get this patient to the hospital?

Question 3: What would your first treatment be?

Question 4: (for advanced credit...) What is your differential list of
problems (diagnosis list) at this time.

Hint: When you hear hoofbeats, look for horses, but occasionally
zebras will show up.

Please respond by email if you think you have the diagnosis list,
otherwise feel free to post to the group.


Charles S. Krin, DO FAAFP
Krin135@AOL.com KC5EVN
"Reckless, Hell! I hit jus' where I was aimin'"
   "Bubba Shot the Jukebox!" Mark Chestnut, 1995