Working on a mystery...

[chbare]

You are called to the scene of a fall at a construction project.

Take care,

chbare.

[sirduke]

Ok, scene sizeup, number of patients, need for additional rescourses, ABC's etc. etc. etc. Help me out here.

[chbare]

You are called by a first responder crew en-route to the scene. You end up intercepting a first responder vehicle. Scene size up shows a 20 year old-ish male supine on the stretcher. He appears unresponsive, apneic, and has gross deformity of his left mid shaft humerous. A combitube is in place and one of the first responders appears to be frantically and rapidly ventilating the patient through port number one. The responders speak very limited English. From what you gather, the patient was working on some sort of construction project, fell onto his left side, and was found by the first responder crew. The fall was approximately 20 feet. Again, hard to establish anything specific related to communication barriers.

The patient was initially pulseless and an AED was attached and utilized. After one shock, the patient developed ROSC. The crew inserted a combitube after ROSC, loaded the patient, and initiated transport.

Take care,

chbare.

[ERDoc]

Hmmmmm...the AED fired on a trauma pt. Interesting.

[Kaisu]

hmm... on a 20ish person, its not really likely that an arrhythmia caused the fall. So, if the fall caused the arrhythmia and the AED shocked it (thanks doc) then I'm thinking maybe commotio cordis. Be that as it may, is the patient being ventilated adequately? I would look after the ABCs, then check out the monitor. Also do a secondary trauma assessment, looking for injuries, especially to lungs (pneumo's etc) and abdomen and pelvis.

[chbare]

You note equal chest rise and fall with sounds throughout. However, the first responder continues to ventilate rapidly. You initiate waveform capnography and note a plateau shaped waveform with an ETCO2 of 18. Additional findings include a small blister to his left hand. Additional assessment findings are difficult as he is still wearing clothing and equipment. You are unable to see any ECG rhythm as the AED is still attached. However, you not a weak irregular carotid pulse.

Take care,

chbare.

[Kaisu]

Well get that silly EMT to slow down on the ventilations. That wave form and the PCO2 indicate respiratory alkalosis. This will lead to muscle twitching, spasms, and weakness seizures, irregular heart beats, and tetany. The blister hmm - was this guy electrocuted? Did he grab a live wire?

[chbare]

Who knows? For us to find out however. Remember, ETCO2 and PCO2 are different concepts. With that, I agree the aggressive ventilations may not be helping the situation.

Take care,

chbare.

[Just Plain Ruff]

ok, fix the lifethreats, stop the hyper hyper hyper (emt) ventillation

IV, O2, Monitor, do whatever fixing the life threats need to be made.

Next have someone go back ot the scene and have them determine what he did.

I'm guessing electrocution but where is the blister at? could it be a spider bite that hurt and he fell off the scaffolding.

CH I kow you are overseas facing heavy combat might this be a scenario from Iraq or Afghanistan? IF so might he have been shot? Or bitten by one of the spiders as big as horses?

[chbare]

You place an IV lifeline. A reservoir is attached to the BVM along with flush oxygen. You note sinus rhythm with frequent runs of non sustained ventricular tachycardia upon performing a quick look. Your partner obtains a blood pressure of 70 systolic. You manage to catch a XII lead and it is noted below. The blister is on the posterior aspect of his hand. The scenario is based on a patient I saw in Afghanistan.

Take care,

chbare.