ShaneAEMS Posted July 9, 2008 Author Share Posted July 9, 2008 Sorry for the delay, I'm sorry I worded my scenario wrong. Upon arrival you get to the pt. That was having labored breathing, responding to painful stimuli. when you pap him. . . After you get him to the ambulance he crashes and goes completly unresponsive. Sorry for the missaccusation.. Link to comment Share on other sites More sharing options...
mobey Posted July 9, 2008 Share Posted July 9, 2008 Sorry for the delay, I'm sorry I worded my scenario wrong. Upon arrival you get to the pt. That was having labored breathing, responding to painful stimuli. when you pap him. . . After you get him to the ambulance he crashes and goes completly unresponsive. Sorry for the missaccusation.. , Soo... responsive to pain only, Then CPAP, then unresponcive, then skin dries up and responsive again? UnCx due to hypoxia, CPAP assisted with ventilation then patient became resonsive again. Could be COPD exacurbation. Link to comment Share on other sites More sharing options...
ShaneAEMS Posted July 9, 2008 Author Share Posted July 9, 2008 No pt. stayed unresponsive during transport to hospital. Intibated suctioned Large bore IV.... but what im trying to get at is what was it that the pt. experienced prior to crash. Diaphoretic skin pale wheezing in lungs bilateraly Link to comment Share on other sites More sharing options...
chbare Posted July 9, 2008 Share Posted July 9, 2008 Still, somebody who is not awake and able to assist with the therapy will make a poor candidate for CPAP. I would not want to use CPAP on somebody who only responds to painful stimuli. Or are we talking about ventilating somebody with a bag valve mask device that provides CPAP like conditions? Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted July 9, 2008 Share Posted July 9, 2008 pulse rate? Any history? Link to comment Share on other sites More sharing options...
ShaneAEMS Posted July 9, 2008 Author Share Posted July 9, 2008 Couldn't tell you wasn't my call. BMV was later attatched into ambulance. Link to comment Share on other sites More sharing options...
mobey Posted July 9, 2008 Share Posted July 9, 2008 I have no idea then. Pretty hard to come up with a decent differential diagnosis off 3-4 symptoms, with no history, med list, or even complete vitals :roll: I say Hypoglycemic, asthmatic, having a major coronary event. Link to comment Share on other sites More sharing options...
VentMedic Posted July 9, 2008 Share Posted July 9, 2008 Shane, thank you for coming back to us. I'm happy to see the BVM was finally utilized. Occlusion of right mainstem bronchus, caused by patient's tongue, secondary to administration of positive airway pressure device (CPAP) in unresponsive patient, contrary to manufacturers recommendations. CPAP can cause airway obstruction with the tongue in a patient that is unable to maintain their airway. The "contrary to manufacturers recommendations" is actually not from the manufacuturer but from the science of ventilation/oxygenation and utilizing CPAP as a mode. This principle of operation would hold true regardless of the setting or equipment. CPAP has been around for at least 50 years. I have used it for over 25 years in the hospital and on transport. Bird and Emerson started their modern ventilator era in the 1950s which included continuous positive airway pressure. Emerson actually started much earlier with negative pressure ventilation (polio) and then developed primitive positive pressure. The old Marks (Manley-Bird) revoluntionized the ability of cycling the pressure into ventilation. Scott, for further clarification, Bird and Emerson (Neil McIntyre MD later) are to the RRT as Florence is to the RN but with a better science foundation. Link to comment Share on other sites More sharing options...
ShaneAEMS Posted July 9, 2008 Author Share Posted July 9, 2008 pulsus normal range , and as far as nursing staff no apparent history Link to comment Share on other sites More sharing options...
VentMedic Posted July 9, 2008 Share Posted July 9, 2008 no apparent history The patient is in a nursing home. How old are they and/or why are they there? What meds have they been taking? Do they have PO intake or G-tube? Chronic O2 use? Link to comment Share on other sites More sharing options...
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