unknown Posted December 17, 2007 Posted December 17, 2007 Bad snow storm, no one is flying. No trains are running either. Well darn it I didn't read down far enough---- HOWEVER-- I have had my flight crews meet and go by ground over long distance trips helping provide a higher level of care for the long ride-- still an option worth a call.
Kiwiology Posted December 17, 2007 Posted December 17, 2007 Well darn it I didn't read down far enough---- HOWEVER-- I have had my flight crews meet and go by ground over long distance trips helping provide a higher level of care for the long ride-- still an option worth a call. LOL. Thats my thinking too - I don't want this guy go go into PEA or total resp arrset on us out here in the boon docks. He needs an advanced airway, now, if worse comes to worse then here's my plan of attack. 1. Continue allbuterol and look at breath sounds and a 12 lead 2. Both are good, I would try 0.5mg IM adrenaline q20 max x 2, although he is not having bronchospasam or constriction I want to try it unless there is a contraindication. I am worried about this guy getting tired and stressed out from having resp diff and I don't want him to arrest, so this should help with that. 3. Load this guy into your guvna'd rig and start towards the hospital, the longer we sit here the longer before this guy gets to def care Now, if the breath sounds aren't good it could possibly be a slowly manifesting edema maybe caused by ischemic problem?? Keep the frusemide handy. I am going with it some sort of hypoxia be it ischemic or environmental. I want this guy in the bus and on the way to the hospital, and keep the whirly bird handy, our local Westpac HEMS chopper is bright red and yellow so it wont run into anything out there in the snow. Maybe Santa does HEMS? I'm not too into an advanced airway because thats not going to help up the SO2 if he has a patent airway but if this guy gets really tired and stressed out from having resp diff then I dont want him to arrest on us. I'd looking towards RSI or a surgical cricothyroid puncture to keep him from having to work so hard to breathe - needle is no good, that only lasts about 45 minutes and our guvna'd rig wont go fast enuf to get him to def care in time! Don't think it will come to that, but it might. Did anybody mention getting a sample of that yellow gunk or getting in contact with the ENT doc yet?
unknown Posted December 17, 2007 Posted December 17, 2007 RSI is what this kid needs. Our flight crews are based out in the rural communities and on more than one occation when the weather was incliment they went by ground with a crew to offer evasive care to a criticle patient. Even as a basic provider this kids needs air way all I can offer him is two (yes it would be uncomfortable) NPA's and a non rebreather at 15 liters O2.
sagigl Posted December 17, 2007 Posted December 17, 2007 i would go for hemolytic anemia, on the background of g6pd deficiency or sickle cell anemia that was exacerbated by the disease or by a medication that was given around the disease or the procedure. anamnesa should concentrate on the family history and the medications that were given- especially antibiotics. treatment would include O2, steroids and finding a way to get to hospital fast enough in order to get blood transfusion if necessary.
Eydawn Posted December 17, 2007 Posted December 17, 2007 I've got a few ideas kicking around. What is this kid's BP? What do his mucous membranes look like? The pulse ox says he's saturating at 85%... but do the physical indications back that up? How do his pupils look? Are his extremities cold? What's his respiration rate now and is there any change to his breath sounds? Does he have a family history or personal history of ANYTHING? Cancer, diabetes, sickle cell, asthma etc? Is he taking any herbal supplements? What home remedies has mom tried for the kid if any? How about OTC's? Prescriptions? Any funny smells in the house or anything that makes you think "uh oh... perhaps we better get out into the nice fresh (if brisk) air"? How much spray did the doc use? Did he get any into his bloodstream from the puncture perhaps? Is it possible that he inhaled some of the local anesthetic, numbing or otherwise interfering with the normal operation of smooth muscle tissue in his lungs? I know this is a long shot... but is there cardiac involvement due to this kid being hypersensitive to the anesthetic? Could he have an arrhythmia going that is causing the SOB? I never did see EKG results... or is the Lifepak/Zoll busted AGAIN goldurnit? The reason I'm thinking cardiac is because lidocaine, the first anesthetic that came to mind, inhibits the ion fluxes involved in neuronal impulses... hypersensitivity to this could mean a tiny bit in the bloodstream could be screwing up the cardiac conductivity... and administration EENT tends to act more like intravascular administration if adverse effects are seen from what I'm reading. Also another zebra... familial malignant hyperthermy in its early stages. Tachycardia and tachypnea with labile blood pressure... I know it's a long shot... I want more information. Since I'm assuming that I'm as screwed as if I were out at summer camp, isolated, no doc on the line, I want to puzzle out as much as possible while I'm waiting for assistance. Wendy CO EMT-B
VentMedic Posted December 17, 2007 Posted December 17, 2007 The mother hands you the card and it says he is an ENT specialist. She says that they sprayed his throat with some numbing spray and then used a needle attached to a syringe to drain some "ugly yellow looking stuff". At the hospital I'd check his methemoglobin but I would expect a higher SpO2 with the additional binding.
Eydawn Posted December 17, 2007 Posted December 17, 2007 Huh? Hey, ventmedic, what are you thinking here? Spell it out for the undereducated basic? Wendy CO EMT-B
VentMedic Posted December 17, 2007 Posted December 17, 2007 Like Carbon Monoxide, some of the "numbing" 'caines have been known to bind with the hemogloblin. I've seen it a few times after endoscopy and bronchoscopy procedures. Usually not as severe but can create some shortness of breath for a while. However, there are a few cases in the literature when intervention must be taken to break the binding.
p3medic Posted December 17, 2007 Posted December 17, 2007 Any chance he had Nitrous as anesthesia? I like the thought on something occupying hemoglobin other than O2, or malformation such as sickle cell, but he has no pain, and no history. At 16 he probably would know wether he had sickle cell or not. How about heart sounds? Any murmur? Is there a possible R to L shunt taking place, and if so why???
AnthonyM83 Posted December 17, 2007 Posted December 17, 2007 Have we determined where in the airway this problem exists? Lungs are clear and he's moving good air and you don't see any inflammation in the upper airway or of the tonsils at this time, right? What does the patient feel? Does he feel this throat swelled up at all? Could the anesthetic caused problem in the opening and closing of this airway further down? Does he have trouble swallowing? Any findings upon auscultating throat area? What has he been doing today since he got back from the doctor? How long after did this start? Any other signs of allergic reactions?
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