Oh again it has happened. I read these forums and something happens so to put alittle twist I think the following senerio (my yesterday) will put a question to your ability for diagnosis in the field. This call kind of supports Crotches argument (omg i said that out loud), but it also will support the limitations of field equipment and I have always agreed that you should treat your patient but most important you should LOOK at your patient, but that can even be decieving.
Called 28 yr old Man down unresponsive 9 am
Scene (its safe) As you approch the scene you see a male, supine, wearing light clothing with a hoodie laying in tall damp grass. The temp is about 8 celsius. The RCMP officer tells you as you are starting your RBS. The males name and that he had called at 3:40 am his phone provider stating that he was going to take all of his pills. The RCMP officer also say's they have been looking for him but where unable to find him until now.
Hx Mental illness, perscription drug abuse, street drug abuse (extacy and cocaine), ETOH abuse. Prior intervenus drug use. (you know this because he is a family member)
Primary Survey
Skin-border line pale and normal color (no cyanosis), cool, and damp, there is also no motteling in the limbs.
Airway is open
Breathing is present
Radial Pulse easily felt
Eyes- Pin point 1 and not reactive
GCS-3
No signs of trauma
Patient placed on stretcher and put in Ambulance (as this is a small town (gotta luv it) you are able to have someone call the Mother and have her meet you at the hospital with his perscribed medications)
Secondary survey
BP 118/80 (you have cut off shirt and hoodie and notice old scaring from track marks, no fresh ones)
Pulse 103 regular
Breathing 10 effective
O2 is 95% (you put 02 on my mask @ 10 liters sats go to 100%)
You are unable to get a BS as his fingers are cool and refuse to bleed (as you are trying to push out the blood he makes a weak attempt to withdraw (but just so slight))
You administer your Narcan sub q as you are unable to find a site for an IV. (patients GCS goes to 5 (pain response, sternum rub) and immediatly returns to a 3.
You are 3 minutes from the Hospital
You arrive and you give your report to the nurses, they go and do their thing, get lab in, and start their Narcan protocols. Also get a temp of 34.5, so warming protocols start.
The mother arrives with a plastic bag of empty pill bottles approx 30 most empty. So many I just handed to the doc and said good luck. He had taken all of the ones that make you sleepy, Lorazipam, T-3's etc. Labs come in and they have confirmed most of the drugs in his system with the addition of cocaine. Also his potasium was at 7 (just thought I would put that in for those who may understand that stuff). Potasium on the second set of labs went down to 3.
After and hour and a half of pushing Narcan his GCS dosnt go above 5 and will immediatly drop to 3. His vitals stay stable but he wont wake up. Dr is Medivacing him and intibates for airway protection.
Crew comes in and does their thing and then we are off to the plane. I had a minute to ask the medic this specific question, "why do you think he wont wake up?". His answer was that because of all of the drugs (some last longer than others) and the combination of them, they may have cause hypoxia of the brain. He even said "even though your pulseox registered 95% when you messured him, it is NOT going to tell you what the 02 levels are deep in the body going to the brain and remember that he was out in the cold and damp and that is a big contributing factor."
Im pretty confident that my treatment was good and well thought out, but was my equipment wrong or was it just not able to do something that we may feel it should. Now since his sats went up immediatly and his airway was open I did not bag him. Now if I did bag him would it have made a difference in his O2 levels deeper in the body, my mind thinks so but with the drug influance I'm a bit at a loss on this one.
Sorry it was long but I felt if I didnt give you the whole story it wouldn't make much sense. I asked his mother before she was able to get on the plane how he was and she stated that he hasn't woken up yet. Im not sure if he is still intibated or not as she is not a good communicator.