brock8024 Posted November 3, 2007 Posted November 3, 2007 It is a cold november morning when you are awaken at 0400 hours and dispatched to a 12 year old male that is not acting right. Upon your arrival you find a mother that is frantic and is yelling at you to help her child. The father directs you to his bedroom where you find your patient. Take it from here.
AnthonyM83 Posted November 3, 2007 Posted November 3, 2007 What do I find? Sex, approx age, size, weight, position, breathing, skin signs, level of consciousness, what does it seem he is doing or was doing last, anything else that stands out as I walk in?
MedicRN Posted November 3, 2007 Posted November 3, 2007 What do I find? Sex, approx age, size, weight, position, breathing, skin signs, level of consciousness, what does it seem he is doing or was doing last, anything else that stands out as I walk in? What Anthony said. I'll add when did they first light their furnace or use their fireplace?
brock8024 Posted November 3, 2007 Author Posted November 3, 2007 What do I find? Sex, approx age, size, weight, position, breathing, skin signs, level of consciousness, what does it seem he is doing or was doing last, anything else that stands out as I walk in? You find a 12 year old male pt that is approx 60lb. pt is supine in bed. Pt's breathing is labored, skin is hot dry, flushed. Pt does not talk to you only cries out for his mother. As far as the heaters they had them cleaned and started and their CO detector has not went off.
AnthonyM83 Posted November 3, 2007 Posted November 3, 2007 Interview Parents: What more can I get out of them? What was he doing prior to to this? What made them get up at 4AM? Was he crying out? What did he do yesterday and days before? Trips or outings? Has this happened before? Normal mental status and ability? Get a SAMPLE. Partner Can your partner do a scene survey of the room, kitchen, garage, and anywhere else they might find toxic cleaning substances, etc? Any smells in the room? Are medications all accounted for? Assessment Now that you're at his side, How is his airway, breathing (rate, quality, lung sounds, visual), circulation (pulse rate, quality, cap refill, PMSC of extremeties), GCS, pupils, BP. Do we have monitor, O2 sat, finger stick, thermometer. Physical exam, signs of trauma or anything else, signs of "SLUDGE"? Will he follow commands enough to tell you what's wrong or point where it hurts or get more of a neuro eval? Tx: At this point, [high] O2 and get IV ready, I suppose.
brock8024 Posted November 4, 2007 Author Posted November 4, 2007 Interview Parents: What more can I get out of them? What was he doing prior to to this? What made them get up at 4AM? Was he crying out? What did he do yesterday and days before? Trips or outings? Has this happened before? Normal mental status and ability? Get a SAMPLE. Partner Can your partner do a scene survey of the room, kitchen, garage, and anywhere else they might find toxic cleaning substances, etc? Any smells in the room? Are medications all accounted for? Assessment Now that you're at his side, How is his airway, breathing (rate, quality, lung sounds, visual), circulation (pulse rate, quality, cap refill, PMSC of extremeties), GCS, pupils, BP. Do we have monitor, O2 sat, finger stick, thermometer. Physical exam, signs of trauma or anything else, signs of "SLUDGE"? Will he follow commands enough to tell you what's wrong or point where it hurts or get more of a neuro eval? Tx: At this point, [high] O2 and get IV ready, I suppose. Parents state that he has been sick for a few days. His mom got up to check on him and he just would not wake up as well as normal. His mother states that he has not had anyother problems normally. Mother states that other than having a stomach flu the past few days he has been great. Last night before bed he was acting really tired. his breathing is labored with some stomach muscles being used. Lungs are clear bilat. Pulse is rapid and weak. cap refill greater than 4 secs. GCS is 9. E=2,V=3,M=4. Pupils Pearl and slightly slugish. BP- 90/40, HR - 148 Sinus tach, FSBS 82 mg/dL. RR 28 labored. Temp is 103.2 F. No signs of trauma. neuro is GSC as above. S- NVD A- NKDA M- No RX meds P- None L- soup last nice E- nothing makes beter. No meds missing. Parents states that they let him alone today while they was at work. No toxic stuff missing.
AnthonyM83 Posted November 4, 2007 Posted November 4, 2007 Avian flu. I'm outtie! How is abdomen on palpation? What did his 'stomach' flu consist of? Cough? Pain anywhere? Soreness? Photosensitivity? Sore Throat? Fever (or is this new onset)? Diarrhea? Vomiting? Eating/Drinking? Any semi-recent injuries?
hammerpcp Posted November 4, 2007 Posted November 4, 2007 He has an infection! Lung sounds? cough? sputum? diarrhea? Aspiration pneumonia for 100 Alex. What is meningitis? maybe SARS. Probably septic. Peritonitis? Oh! Rabies! Does he have any hx? Start some NS anyway. Does he need ventilatory support?
AnthonyM83 Posted November 4, 2007 Posted November 4, 2007 Oh and how does his condition change after O2. I'm to decide what to do with airway/breathing. Would 12-lead (enroute) be too much? I'm just thinking that b/c obviously not perfusing well. I'd start loading now.
Recommended Posts