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PPT : Case Conference: Respiratory Failure in Term Pregnancy

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Pt. was Cambodian-speaking only, 42y/o woman c/o SOB since yesterday, worsening tonight.
Thru a translator described “chest tightness”, “pain coming from abdomen” (pt. 9 mos. pregnant) and cough (unproductive).
Pt. progressively and noticeably worsened en route.”
Alameda County EMS
* HPI:
o 42yo woman – G6P6 (with twins this pregnancy) with hx HTN + DM presents with acute SOB tonight.
o 9 mos. preg. — EDD 2/22. Saw Ob yesterday, EDD moved to March. Ø SZ.
* PMH: GDM, PIH, amniocentesis x 2 normal
* Meds: Insulin, PNVs, Robitussin
* NKDA
* Social history:
o Married, six children ages 14 and up.
o Unplanned pregnancy, husband wanted to keep, pt. did not.
o Hx domestic violence, resolved.
* Review of systems:
o Nonproductive cough since 30wk EGA
o chest tightness
o abdominal pain
Alameda County EMS
Physical exam
* Vital signs:
o T 99.4 pr, BP 230/130, HR 130s, RR 30s SpO2 92% on 10L by FM
* General:
o Very distressed, grasping companions, asking for help, breathing as if drowning
* Resp:
o Sitting straight up, rales 1/2way up bilaterally
* CVS:
o tachy, reg, 2+ pitting edema bilaterally, ø JVD

Alameda County EMS
Physical exam (cont.)
Alameda County EMS
o 130/90 82%, labs drawn & sent,
o Etomidate 10mg, succinylcholine 120mg

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PPT : Case Conference: Respiratory Failure in Term Pregnancy Category : Pregnancy
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