DwayneEMTP Posted December 26, 2007 Author Posted December 26, 2007 Blood sugar and skin signs / temperature ? No time for BGL (But the EMS God tells me it isn't an issue), Skin and temp w/n/l for situation.
Kaisu Posted December 27, 2007 Posted December 27, 2007 Is this the same medic that is making life miserable for you? I don't understand poor compliance with an intubated patient. Do you hear lung sounds when ventilating?
Mateo_1387 Posted December 27, 2007 Posted December 27, 2007 I'd say go ahead and give 1mg of epi 1:1,000 IM. Obviously the patient is about to code without any breathing, and we'll be giving 1 mg IV when he codes in a minute. Besides if he is a tight asthmatic it will start helping to open his lungs and also will increase his BP. I know most people are thinking OMG, he should only give up to 0.5 mg IM, but nah, give the 1 mg....
p3medic Posted December 27, 2007 Posted December 27, 2007 Epi sounds like a good idea, we can debate the dosage, but it is the one treatment that makes the most sense. The diff's are few, mechanical obstruction below the level of your et tube (pretty much dead pt) tension ptx, probably not, but might be the next thing to consider in tx, and acute bronchospasm. I agree with the epi, gain IV access, and put patient on the monitor...Oh, and EtCO2 s/p intubation?
Kiwiology Posted December 27, 2007 Posted December 27, 2007 No breath sounds, ok, so this guy is obviously not breathing. That's my main issue. If he has COAD or asthma or some other resp disorder / allergy he's going to have to meds or a medic alert bracelet or something of that nature. I would start on O2 at 8 lpm and check out ETCO2/chest rise & fall and re-evaluate breath sounds with a view toward BVM if he's not improving and requires manual ventilation. I am thinking this is one of the following: 1. airway obstruction: laryngascopy and remove with McGills forceps or push the endotracheal tube right down to dislodge the object. 2. asthma or COAD: 0.5mg IM adrenaline and get an IV line, if not improving intubate and start infusion of 1mg epi/hr in a litre of NS with epi boluses of 0.01mg IV as required q1-2. 3. allergic rection / anaphalyxis: 0.5mg IM adrenaline, if not improving intubate and start infusion of 1mg epi/hr in a litre of NS with epi boluses of 0.01mg IV as required q1-2. I would be interested to see how this turns out: I don't think its poisioning or a sting or some kind because I'd suspect he would have mentioned it to the EMD. What about environmental: gas leak or something?
AnthonyM83 Posted December 27, 2007 Posted December 27, 2007 No time for BGL (But the EMS God tells me it isn't an issue), Skin and temp w/n/l for situation. Well, I'm out. We had a patient exactly like that last night. As soon as we rolled into ER, the doc called it was one of those. Turned out to be both...but sepsis was the main one.
DwayneEMTP Posted December 27, 2007 Author Posted December 27, 2007 There are no environmental causes involved here... You give somewhere between 0.5-1mg :wink: epi SQ. Your patient's heart rate increases to 220, shortly there after he codes, you follow ACLS protocols to the hospital but he remains dead... Is this the same medic that is making life miserable for you? I don't understand poor compliance with an intubated patient. Do you hear lung sounds when ventilating? Yeah, same one. No noticeable lung sounds while ventilating. In fact, it seems that since achieving the tube, you have lost compliance. Bagging is becoming more difficult. The EMS God takes back the epi/trip to the hospital, and returns you to the living room floor... You notice (The medic says this should have been one of my first questions) that the patient is thin, and approx 6'6” tall.... This patient, assuming the medic gave me an honest call and a fair scenario, is savable. I truly do feel much better here. I was told in this scenario that one intervention should have been a no-brainer. I eventually got to it, but it was no where near the top of my list... What's next?
vs-eh? Posted December 27, 2007 Posted December 27, 2007 You notice (The medic says this should have been one of my first questions) that the patient is thin, and approx 6'6” tall.... Well, obviously with that I am going to assume it is some sort of spotaneous pneumothorax/bleb. But spontaneous bilateral simple/tension pneumo's leading to a pre-respiratory arrest? Hmmmm...
Lone Star Posted December 27, 2007 Posted December 27, 2007 Would spontaneous pneumothorax present similarly as FBAO?
DwayneEMTP Posted December 27, 2007 Author Posted December 27, 2007 Would spontaneous pneumothorax present similarly as FBAO? It didn't really here. The lack of audible breath sounds does not rule out the possibility of air movement, you simply couldn't hear it here. And there was not a lack of compliance with the bag as I would expect with FBAO, though I could be wrong I guess, just very poor compliance. It was explained to me like this. (after I tried epi...dead. Next time tried mag sulfate to attempt to loosen him up....dead. Dropped a tube...dead....gave him glucose ...dead, RSIed him ,(thinking maybe she was giving me some kind of seizure/lock jack/hypothermia/gonorrhea combo scenario)...dead, dead, dead. Kicked him, called his mother names...Still dead) Finally I attempted to decompress, simply because this was the only part of his body I hadn't broken, poked, poisoned, or damaged in some manner in previous scenarios. Medic :"You hear a loud hissssing, etc. Why didn't you do that sooner?" Me: "I didn't have a reasonable suspicion of a pneumo." Her: "Why? Tall, thin, little compliance to the bag. He's already mostly dead. What did you have to lose? By the way, I saved this patient. You killed him. All of them." Me: "Oh yeah! Well you're just a big smelly stupid head!!" (Yeah.....didn't really say that). Besides...I did save the last one... :oops: Anyway...should I run into this scenario in the future, I'm still not sure exactly what I should do, how I would verify it? (Hey! Percussion maybe? He should have sounded pretty dang hollow I'm thinking) But I was interested in everyone's thoughts. I'm happy that many of you much smarter than I went down the same logic path that I did...FBAO, asthma/anaphylaxis, laryngospasm, heart failure, etc. I'm not sure I'd even heard of an spontaneous pneumo before this... Anyway...have a great day all. I'd love to hear your experiences if you've dealt with this before... Dwayne
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