spenac Posted April 10, 2008 Posted April 10, 2008 In a remote part of the world you find yourself with a call. You get a 911 call to an area that is almost a 2 hour drive to reach. That means once you reach your patient you are 3 and half hours from nearest hospital. You have no air support. Just you and your basic partner. Welcome to my world. Dispatched to XYZ for woman in severe pain and extremely anxious. You ask if trauma. No trauma. Unknown cause of pain. You ask if anyone can drive her to meet ambulance. No one is available to drive her. So off you go bouncing down the rough roads at a top speed of 45mph which is to fast especially once patient is on board. Finally after you are extremely sore and tired from the road you get on scene. Patient is seen pacing one hand holding her low back other keeps grabbing at her crotch, then up to her chest. She appears other than that to be a healthy in shape 20 - 30 year old female. You walk up to her and ask what happened? Patient in complete sentences says she does not know. She had driven out to check on the familys ranch. She stopped and went to the bathroom at the outhouse near the entrance then continued on back into the ranch. She started having a little low back discomfort and figured it was because of the long bouncy ride out. Then discomfort after an hour or so became unbearable pain low back, thighs and now she is having chest discomfort. She says she can not stay still. She had attempted to drive down to ranch entrance and almost wrecked. "Am I going to die?" The entire time talking to you she continues pacing and moving arms. You patients name, age (26), address, insurance, are on paper she has with her. Alright lets let you guys get involved. Again it is just you and your partner for the next 3 and half hours to the hospital. Don't request flight, additional ambulance, med control as radios and phones don't work until 10 minutes to hospital.
Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 my first suspicions are kidney stone lumbar spine sprain due to wonderful roads you call superhighways out there. Well first I'll do all the requisite things Vitals history iv lock at least 12 lead just to be sure if she has to go pee I'd catch that just in case for a baseline for the ER. I'd put some oxy on her at 4lpms just because I can. I'd begin with toradol if you have it. If not I'd start with 2mgs Morphine which on my standing orders I can give since I have no contact with med control for 2 hours and 50 minutes How much Morphine do you have on board? Do you have nitrous? That's jsut the start of it all but I'm also going to have in the back of my mind a dissecting AAA due to the pain. It could also be another great vessel isssue too. We are only 3 hours into this nightmare that is being presented to us by our favorite taxi driver.
Leener77 Posted April 10, 2008 Posted April 10, 2008 Any possibility of a bug/spider bite?? Maybe when she was in the outhouse?? Was she exposed to any substances/chemicals on said ranch?? I know those possibilities are a bit of a stretch but ya never know!!
spenac Posted April 10, 2008 Author Posted April 10, 2008 Are you pregnant? Don't think so. ( Do ya'll really believe thats all we get out here? ) Are you allergic to anything? Just seasonal allergies. Any health problems/meds? No. Did you use any chemicals recently? No. Has anything bitten you? Not that I am aware of but did feel something on me in the outhouse, just brushed it off so don't know what it was. Basic Vitals Pulse: 114 reg Resp: 20 reg BP: 146/126 confirmed machine and auscultated both arms EKG 12 lead : Sinus Tach Skin warm, moist, and what you see with her sitting there normal in color.
Leener77 Posted April 10, 2008 Posted April 10, 2008 Where was this 'something' she felt on her in the out house?? Check the area (and areas around) for any suspicious marks and/or coloring......
Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 oh now you put the outhouse in there. Look for a scorpion sting or a small bite mark from a black widow or other poisonous critter. Go look around the outhouse for the offending scorpion or spider (you probably won't find that though) More than likely she would have felt the scorpion sting but she probably would not have felt the spider bite, rarely is there immediate pain on a black widow spider bite. Black Widow Spider Bite Symptoms The black widow spider produces a protein venom that affects the victim’s nervous system. Some people are slightly affected by the venom, but others may have a severe response. The first symptom is acute pain at the site of the bite though there may only be a minimal local reaction. The local pain may be followed by localized or generalized severe muscle cramps, abdominal pain, weakness, and tremor. In severe cases, nausea, vomiting, faintness, dizziness, chest pain, and respiratory difficulties may follow. The severity of the reaction can depend on the age and physical condition of the person bitten. Children and the elderly are more seriously affected than young adults. In some cases, abdominal pain may mimic such conditions as appendicitis or gallbladder problems. Chest pain may be mistaken for a heart attack. Blood pressure and heart rate may be elevated. People rarely die from a black widow's bite. Life-threatening reactions are generally seen only in small children and the elderly.
spenac Posted April 10, 2008 Author Posted April 10, 2008 Pretty much unlimited supply of the following drugs kept in ambulance: Activated Charcoal with Sorbitol, Acetaminophen, Adenosine, Albuterol, Amiodarone, Chewable Aspirin, Atropine Sulfate, Brethine, Calcium chloride, Calcium gluconate, Clonidine, Dextrose 50%, Diphenhydramine liquid oral and injectable, Dopamine, Duo Neb (0.5mg ipratropium, 2.5mg albuterol in 3cc saline), Epineprhine 1:1000, Epinephrine 1:10,000, Furosemide, Gluctose, Haldol, Ipecac, Lidocaine drip, Lidocaine HCL 2%, Magnesium Sulfate 10%, Morphine Sulfate, Naloxone, Nitroglycerin, Nubain, Oxytocin, Oxygen, Procainamide, Promethazine, Racemic Epinephrine, Regular Insulin, Romazicon, Sodium Bicarbonate 8.4%, Succinylcholine, Toradol, Vasopressin, Verapimil, Versed, Vistaril, 0.9% Sodium Chloride: 1000cc bags, Lactated Ringers: 1000cc bags Right now thats what I recall from our drugs. I think I missed some and may have duplicated sorry. If you need something else ask and I'll see if it is available to you.
Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 well I'd start the iv and keep it open, forego the lock. I'd start with 30 mgs of toradol and then hit the morphine if needed. I'd also if we are going to go down the road of the spider bite, I'd have some epinephrine ready in case of allergic reaction.
spenac Posted April 10, 2008 Author Posted April 10, 2008 oh now you put the outhouse in there. It was in original post. Learn to read . J/K. But it really was there from the beginning. You tell her you need to see the area she felt the unknown critter on her. She says it was on her upper inner thigh. Since you suspect maybe a bite do you leave her in her clothes? How closely do you want to look? Partner comes back from the outhouse. He whispers that he feels much better and says he saw no critters.
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