Paramedics on the field
You are working as an Extended Care Paramedic (ECP) in a Metropolitan Ambulance Service. A patient is referred to you by a Paramedic crew.
The patient is a 48 year old woman with a 2 week history of a productive cough with green sputum, and is complaining of general malaise and fever.
On examination:
AIRWAY – patent
BREATHING – 18 resps/min, SpO2 = 97% room air
CIRCULATION – pulse = 87, BP = 130/80mmHg
DISABILITY – GCS = 15, BSL = 5.1 mmol/L, PERL, nil neuro deficits
EXPOSURE – temperature 38º, nil rash
Past medical history: depression, exercise induced asthma
Medications: Zoloft
Allergies: Penicillin
Explain your systematic respiratory assessment.
Explain the Pneumonia Severity Index (PSI) Class 1.
Outline the exclusion criteria that would prevent you from managing this patient at home. Include in this a discussion of ECP Scope of Practice and the Inclusion/Exclusion Criteria for such services as Silver Chain or Doctor in the Home.
Outline your treatment regime.
What other advice might you give the patient?