Pubic #'s

whilst on my community prac, we visited a 60 yo lady who had a bilateral sup/inf rami # and was discharged from hospital the day before. the other curtin physio was going to ax and rx the patient and the supervisor and i were observing. the pt had a high respiratory rate and was breathless when we arrived and seemed unable to catch her breathe which she reported as very unusal for her. she tired very quickly during the strength and balance assessment and had an irritating cough which she reported caused her mild chest pain. as the session progressed the patient reported feeling well, so we decided to finish off the session with some bed exercises. the patient lay down in the bed and started feeling really sick, she asked us to cal the ambulance and as our supervisor was making the call she started fitting and foaming at the mouth, she was completely un-responsive. as the fitting stopped she slowly started to follow commands and seemed to be improving. we put her in the recovery position which caused a lot of pain from her pelvis and my supervisor asked the other student to wait outside for the ambulance. the ambulance seemed to take forever to get there, it actually took about 15 minutes and the patient kept dozing off and my supervisor and i tried to keep her talking. when the ambulance arrived, the patient seemed much better and the paramedics weren't worried, they attached her to an ecg to check her heartrate which looked normal and they put her on oxygen. one of the paramedics went back out to the ambulance to bring a chair inside to wheel her out to the ambulance. the other paramedic was on the phone when the patient started fitting on the bed again and the ECG monitor flat lined, the paramedic got us to help take her off the bed onto the floor and we started trying to resuss her. when the other paramedic came in they had to use the defib three times before getting a trace. as the patient was so unstable, our supervisor had to go in the ambulance and continue helping with CPR on the way to the hospital. we got a phone call later that afternoon saying that the patient had suffered a massive bilateral PE and passed away, i got a bit upset and we called the hospital back to get a bit more information only to be told that the patient had had a massive bilateral PE but was still alive in ICU. the patient did end up surviving and was discharged home a couple weeks later, only to have her initial physio visit post discharge as my final assessment! needless to say i probably went overboard asking how she was feeling throughout the session! what i learnt from this experience is that even though a patient has been deemed safe for discharge, you still have to monitor them carefully throughout treatment. i now know that - SOB, rapid brathing pattern, chest pain and cough are all signs of a PEand PE's are most common in pubic #'s.