Timmy Posted October 26, 2008 Posted October 26, 2008 You’re an EMT at a local football match. Though out the game you have noticed one of the ‘star’ players acting a little out of sorts, he appears quiet from his normal energetic, bubbly self. At half time he approaches you asking for some pararcetamol for a minor headache, he states he has not received any blunt force trauma to the head, is able to answer all your questions and states he hardly had any sleep the night before but he feels fine. With that you administer 1000mg pararcetamol buccal, encourage him to keep up his fluids and you keep an eye on him for the rest of the match. He is not pallor, has good coordination and everything leads to him just feeling tied (not unusual for the players to show up like this on Saturday morning) After the game you’re attending to the minor injuries, bumps and icepacks when another player screams out your name from the showers, upon arriving you find this player up against the wall, in a semi recumbent position near the toilet, you note about 200mls of emesis on the floor, the player is unresponsive. What next?
defib_wizard Posted October 26, 2008 Posted October 26, 2008 call 911 and panic just kidding! But do call for an ambulance. Move him out to a less enclosed area & open his airway. Put him on his side if he is vomiting. Is he breathing? what about his pulse? does he have one. If not then cpr and get an aed. Does he take opioids how about narcan maybe even check his bgl. I need more info like v/s pupils and what equipment is available.
Timmy Posted October 26, 2008 Author Posted October 26, 2008 He is breathing, quiet shallow and slow. You have quiet a lot of trouble getting him out of the cubical, his quiet a well built kid and his half wedged up against the wall and door, damn those inward swinging doors! His airway is clear, no noise on respiration. ALS road crew is on the way, ETA 30 mins. His on no prescription medication, you went to school with this kid and can be pretty certain that rec drugs are no issue, but you never know. Pupils are 3 PERL BGL comes up as “low” meaning it's bellow 3mmol. He has no history of diabetes. His normally a fit and healthy kid, no medical issues apart from a recurring ankle sprain. Equipment: 02 bag w/ suction, OPA Spinal gear First Responder bag BGL monitor Sp02 monitor BP cuff and steth Meds bag with nill invasive... No IV gear. You have oral glucose, paracetamol, salbutamol ect.
mobey Posted October 26, 2008 Posted October 26, 2008 below 3mmol hey...... Well you could swab his oral mucosa with the glucose, and suction...... but I would be pretty careful. Mine as well get vitals and start a nasal canulla.
Timmy Posted October 26, 2008 Author Posted October 26, 2008 BP: 90/60 Pulse: 60, weak Spo02: 95% RA Resp: 14, shallow BGL: <3 GSC: 4 A nurse who is a parent of another player comes in to help, you both decide that the oral glucose is the best thing you have at the moment. You apply a tiny amount under his top lip. A few mins later he slowly opens his eyes, is not able to talk but you communicate but yes/no questions by asking him to squeeze your hand. You have time to ask a few basic questions before he goes unresponsive. He still wasn't concious enough to comprehend putting anything in his mouth. His eyes kept rolling back into his head. What questions would you ask in that time frame? It has been quiet warm all day and another player informs you his been at a party and has vomited at least once whilst on the field.
mobey Posted October 26, 2008 Posted October 26, 2008 I won't trust the answers he gives me anyway... but Ask about drugs & Meds ( he may change his story) Significant past med history Ask about pain at present. Keep on using the glucose in small amounts, and wait for the Ambulance. How is his skin? 02 sats improve with nasal cannula? Air entry sounds? Abd exam too please
Timmy Posted October 26, 2008 Author Posted October 26, 2008 No change in the story, no meds, no histroy. Skin: clammy and diaphoretic 02: 98 on 02 Lungs sounds are fine, clear bilat. Abdo: Nothing to report on, nill distention.
rock_shoes Posted October 26, 2008 Posted October 26, 2008 What's his temp? Does he have any family you can get more of a medical history from? Perhaps a team medical form you can draw from? Do you at least have an OPA or NPA you can stick in while waiting for ALS?
akroeze Posted October 26, 2008 Posted October 26, 2008 Any medic alert tags/devices? Do you carry glucagon? If so I'd give it to him Recheck BGL after a tube of oral glucose
Timmy Posted October 26, 2008 Author Posted October 26, 2008 There's no history that I haven't mentioned already. Its a hot day, his been playing football, throwing up, been to a party, had no sleep and now his like this. OPA is down, continuing with glucose. The ALS ambulance is on scene, your the crew... Take it away.
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