nypamedic43

Is she a hemopheliac? or have some other type of blood disorder that will not allow her blood to clot? The ASA and Plavix she has been taking could very well make that kind of disorder even worse. Since she is now unresponsive how do we know that the only trauma was the accident? I would start another line with ringers and run it wide open. I would also have DFIB hold pressure on the cut...( we are already covered in her blood, a little more wont make a difference) Notify medical control of what we have, whats been done to this point and advice on what to do next. I would also be ready to intubate and support her completely as well as CPR if needed. Oh yeah...she gets a diesel bolus as well but we are missing something....I just cant quite figure out what.

It's very expensive. A company north of us here in NY has one, thier's doesnt have that particular system, and you still have to pick the stretcher up, with the patient on it and then engage the hydraulics to pick the wheels up. There is also a system that has a winch on it. IMHO...it takes longer for the hydraulics to pick the wheels up than it does to just get a regular stryker and pick the wheels up yourself and at half the cost. And if the hydraulics give out..you are basically screwed.

*snicker*

After 2-3 weeks the vaginal bleeding should have stopped by now. The car accident involved abdominal trauma that caused the miscarriage. What quadrant is her belly distended and rigid? Lower quadrants I would guess a perforated uterus because of the D and C. If the impact from the accident was enough to cause abruptio placentae,she could also have a ruptured uterus that they didn't catch earlier or made worse because of the D and C. I'm not sure about the TQ. I would use it as a very last resort, if additional dressings and pressure didn't get the bleeding to stop. I would also would not be hosing fluid in. Giving the 250 mL bolus should be enough to bring her pressure up but she is already starting to decompensate and ringers or saline don't carry oxygen, so I would be careful about that. It's pretty obvious that we are behind the 8 ball with her.

We arent "made"..we are trained. Nobody is perfect and we are human. We make mistakes. The secret is learning from them and not making them again. And experience comes with time...you cant walk out of school and be "perfect".

With the ASA and Plavix, that explains why the cut wont top bleeding. Put another pressure dressing on it. I am also guessing that the rash is a subq bleed. Oxygen at 15 liters by NRM. Get her on the stretcher and into the ambulance. Start an IV of ringers, draw bloods (if you have it) or saline, I would also put iher in modified trendelenburg and give her a 250mL bolus, then cut it back to KVO and reassess BP. Cardiac monitor. With the ASA and Plavix, her INR may be too high.

ok...so she is shocky with an elevated pulse and low BP. Car accident that caused a miscarriage, 3 wks ago, and abdominal pain since. How did she cut her arm while cooking? most people cut thier hand or fingers...not thier arm...just sayin. The rash is kind of strange. Medication reaction maybe? Is she depressed because of the miscarriage? Does she meet your gaze when speaking to her? Does she have a flat affect? ie: no show of emotion. Something is off with the whole cut on the arm thing. Where is the cut located?

I would love to go ahead and run with this scenario but I'm going to wait for some more responses from basic providers

What does the house look like? Does it look like there's been an altercation? Is the patient alone in the house? Get a quick run down of what's going on. Where is the pain? Where is she bleeding from? How does the patient present? Is she doubled over? Sitting Up? Does she watch me come in the door? Any physical signs of trauma? Until those questions are answered I don't take a step further inside the door and am prepared to back out and wait for PD. Too many variables to just go barging in on this one.

Wow CM!! Reading that story gave me goosebumples. Sometimes it isnt the skills we perform like a 12 lead...its the simplicity of holding a hand...or applying an ice pack. Thanks for sharing

not me thats for sure...not when I run 12 calls in a 9 hour shift anyway and when I get home I'm to tired to do anything but fix my son dinner and then veg on the couch...or come on here and drive everyone batshit crazy

I agree as well. Cramming last minute will only land you confusion and a blank mind when you read the questions. By cramming you will effectively shut yourself down. Leave it alone and, if you have studied during class and done well throughout, you will do fine on the final test.

#10 is definitely hard for me. However #18 is my motto

Lol Ruff...ooops I mean capt kickass

I too, have been as honest as I could be on this forum. My avatar is me...in all my glory LOL!! My first screen name, nypaemt39, was created when I worked for a different company and being dual certified hence....NY PA EMT 39...the 39 was my employee number. My name is basically the same now except for the cert change and employee number change.

I truly felt like there had to be a physical reason for this sudden bizzare behavior. Sudden onset of a diabetic problem, a bleed or an OD of some kind. With the Doc denying narcan, I felt like my hands were tied as far as trying to correct what was wrong. I know that they did a shit-ton of tests and a CT. His wife was scared to death and there wasn't anything that I could tell her that could put her mind at ease. I do believe that a blanket diagnosis of "psych issues" are over used especially when there is no physical reason for the diagnosis. Dr. Lux hasnt been on duty since that day so I really wasnt able to pick his brain and by the time the weekend is over he probably wont remember the patient. Arnot is on diversion for almost everything and shipping patients to the hospital across town, so general illness, shortness of breath calls etc, are being diverted there. Cardiac, stroke and major trauma can still go to the Arnot as they are the stroke center and have the heart institute and OR suites with staff available. I just thought that this was an interesting case and by the responses, I wasnt the only one a little stumped by him. It really was a good learning call. Thanks everyone for participating edited for spelling

I was really thinking that this guy had a bleed. His behaviour was so bizarre. He most definitly had me thinking...hurt my head

I'm gonna go ahead and tell you all what was going on with this guy. When I checked up on him a couple hours later, the nurse told me that there was nothing physically wrong with him. He had had a "psychotic break" as she put it. It was brought on by unrelieved stress and his body just decided that it had had enough. He was released home after a few hours of observation...with new prescriptions and a lot of advise from the Doc.

EKG remained normal no matter what state of consciousness he was in. The allergy meds were over the counter. I remember seeing a Claritin box on the kitchen table. The old meds that were in the bathroom, to be honest, the only one that I remember is meclizine. As for the TIA 18 months ago, the symptoms cleared within an hour of onset and he has had no other incidents with them.

CT was normal. No lesions, bleeds or masses. No alcohol use. Patients ECG was normal during the periods of unconsiousness. They lasted as long as I let them. ie: sternal rubs and yelling at him to wake up. Periods of being awake lasted a minute or so before he passed out again. I gotta tell ya this guy had me stumped and asking what else I could do for him. Luckily transport time was about 5 minutes and we were on scene with him about 7 or 8...so 12 or 13 minutes from time of call to delivery at the ED.

patient is 41 years old, hasnt been ill but has been stressed. his temp was normal 98.4 I think the nurse said. wife was unable to give me details about the breakdown in '98, just that he had one. CM the BP was 150/100 when he was awake and the 142/90 was when he was out

no history of seizures CM. you?? blush?? LOL!! and that poor sweet lady :/