Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 I want to see the bite. i also want to remove any restrictive garments and jewelry and the like. If it might cause constriction remove it. Rings, necklaces, bracelets and watches. Bra's and socks too. The rest of her clothes if spenac thinks she's hot!! :twisted: Good thing is if it is a spider bite it usually isn't fatal. What's her underlying heart history and basic health history? how long are we into this transport so far?
spenac Posted April 10, 2008 Author Posted April 10, 2008 Maybe when she was in the outhouse?? Good job paying attn to the little details.
mobey Posted April 10, 2008 Posted April 10, 2008 Since you suspect maybe a bite do you leave her in her clothes? How closely do you want to look? I would strip her and put a gown on her (If you carry gowns...we do). I am going to continue to observe the area of the bite, given I found one. I also would like to spend some time calming her maybe coached breathing would help. This may allow her to better localize the pain.
spenac Posted April 10, 2008 Author Posted April 10, 2008 You tell her you need her to remove her clothes. She slaps you and calls you a pervert. So you explain to her the need to see if she is bitten. You also explain that anything restrictive could become an issue if she starts having problems later. She finally agrees and asks can I keep my pantys on? ( you decide? ) Exposed skin of upper inner thigh shows no signs of bites or stings. (Do we continue exploring?) You have IV established. No relief from Toradol or initial dose of morphine. Vitals unchanged. 15 minutes have expired.
mobey Posted April 10, 2008 Posted April 10, 2008 can I keep my pantys on? ( you decide? ) (Do we continue exploring?)
spenac Posted April 10, 2008 Author Posted April 10, 2008 "Is she hot?" She just was cover of swimsuit monthly. Does this change your treatment? :twisted: After you explain the need to rule in or out a bite she removes her panties. At first nothing is visible but as you palpate the area including lower abd it causes the labia to spread and you see a dark spot. Also noted that ABD is rigid. But is not tender to palpation. No problems noted on palpation of and percusion of back. Pain is now at 20 on 1 to 10 scale. She keeps laying down, sitting up. Rolling, etc. She can not stay still. She pukes on your new boots. She keeps asking if she is dieing? Skin is now drenched. Complains that the light is hurting her eyes and makes her head feel like it will explode. You are 30 minutes into the transport. Only 3 more hours to the hospital if we don't have ambulance problems. Vitals Pulse 140 BP 162/148 Resp 24
Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 is that blood pressure right? did you take it manually or are you relying on that piece of crap automatic bp machine? If it is then we are gonna be in for a long long ride. How old is this lady? does she admit to any history of trauma What does her chest look like other than exactly like it should on a swimsuit model.
Eydawn Posted April 10, 2008 Posted April 10, 2008 Describe the dark spot. Is it a mole, a freckle, a raised bite, does it have pinprick marks in it, is it a small hematoma, a tick, what? I'm also throwing in brown recluse as a suspect here... dizziness, restlessness, nausea, chills, shock... those little bastards are very nasty. And if she's got a brown recluse bite on her vajayjay, she's in for a long painful deal if she makes it that far... Black widow spider is a good critter to have a high index of suspicion for. I'd be looking for any other potential bite sites, regardless of critter, on her buttocks and lower back as well. Why is her BP so freakin' high? Does she have a history of hypertension? How about meds... she on anything that might complicate this? How's her LOC? Decreasing? Remaining the same? How far are you from the hospital, and do you have flight available to come yoink her outta there if necessary? Wendy CO EMT-B
Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 I'm not so concerned with the 162 as that could be due to her extreme pain and Spenac's driving habits. What I'm concerned about is the bp of 162/148. Original bp was 142/120 its the narrow distance between the top and bottom number that has me really worried. What's her 12 lead look like? Gotta ask her about drugs, any drug use while using the outhouse? What are her pulses in her arms and legs like? ARe they equal in the arms and equal in the legs or are they different. Does she relate any history of a tearing sensation to her scapula?
spenac Posted April 10, 2008 Author Posted April 10, 2008 Original vitals were: 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. You decide to get a better BP and to examine the spot within out an embarrassing face plant to her vagina so you decide to stop the ambulance. You have to throw something thru the window to get your partners attention as he's to busy listening to his ipod. BP 158/138 Pulse 132 Reg equal all extremities. Resp 28 EKG Sinus Tach You explain to her that you need to look closer at the possible bite and check the rest of her body for any other possible sites. You gently open the vagina and look at and feel the area. It has the basic look of a black widow bite. No bites found anywhere else. You ask about possible drug use. She says no. BP is normal if not low normally. LOC normal but extremely anxious. No tearing sensation. Just intense pain and cramping. -5 to eyedawn for asking about resources that are not available per OP. But good try sneaking it in. Nearly 3 more hours to hospital if no problems. Patient screams at you "HELP ME".
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