spenac Posted November 21, 2008 Posted November 21, 2008 Another thing to think about is toxic shock syndrome. She is old enough to be going through puberty. A full secondary exam is in order. So your going to check for tampons?
reaper Posted November 21, 2008 Posted November 21, 2008 UMMMM. Perhaps you need to look at updating yourself. Coma cocktails are on the out, at least in the field. I was thinking the same thing. I haven't used a coma cocktail in years.
crotchitymedic1986 Posted November 21, 2008 Posted November 21, 2008 yes a tampon test is in order--- if it tastes sour, definitely toxic shock --- and are you saying you wouldnt narcan this patient. I have been around long enough to see what works and what doesnt, and how treatment protocols change every 2 years so a new book can be printed and purchased. For instance, Calcium Chloride converted more cardiac arrest patients than mega dose epi, vasopressin, or AEDs ever has combined --- but the PHDs seem to think otherwise.
Christopher.Collins Posted November 21, 2008 Posted November 21, 2008 You are dispatched to a rough looking hood at 9pm Im ganna curl up in the back with my Teddy Ruxpin a pacifier and my glock. My partner will assess the scene and initiate care untill PD arrives... then for radio me.
defib_wizard Posted November 21, 2008 Posted November 21, 2008 I would look for a string. ( AKA rip cord ) plus other signs. Blood tinged panties, bad odor. I have to agee with a lot that has been posted Secure the airway, assist ventilations, Start an IV ( large bore ) give a 20cc/kg bolus. Narcan 2mg check a bgl give D50 if <60mg/dcl You should also consider spinal immobilization. Get her to the hospital. let leo's take care of the other children.
spenac Posted November 21, 2008 Posted November 21, 2008 yes a tampon test is in order--- if it tastes sour, definitely toxic shock --- and are you saying you wouldnt narcan this patient. I have been around long enough to see what works and what doesnt, and how treatment protocols change every 2 years so a new book can be printed and purchased. For instance, Calcium Chloride converted more cardiac arrest patients than mega dose epi, vasopressin, or AEDs ever has combined --- but the PHDs seem to think otherwise. And the problem with EMS as illustrated by your statement: We've always done it this way so we'll keep doing it this way. Yes things change daily and return to old at times but we need to be willing to look at the possibility that the new ways could be better.
Eydawn Posted November 21, 2008 Posted November 21, 2008 I'm not leaving any 5 year old or 3 year old at a scene without an adult, period. Unless the LEO's get there right as I'm ready to leave, the kiddos come with in car seats. Wendy CO EMT-B
ERDoc Posted November 21, 2008 Posted November 21, 2008 You need to keep your differential broad in a case of AMS. I think infectious/sepsis is a definite possibility. TSS should also be on your list. I would not start hitting her with narcan without reason to suspect that she OD'd. Crotchity, please, no more coma cocktails. Use your assessment skills to guide your treatment. Also, is she pregnant? Ectopic? Just things to keep in mind.
crotchitymedic1986 Posted November 21, 2008 Posted November 21, 2008 If you read back a little further you will see that pregnancy was the first thing that i asked about. And its not that I am against new treatments, i have just been around long enough to see things come, then become taboo, then come back again -- or worse the continuous cycle of jumping to the next greatest drug or treatment only to find out that the outcomes don't change. And before you discount coma coctail as old school and ignorant --- if you have a diabetic patient that is symptomatic of textbook hypoglycemia, all the signs and symptoms, but your glucometer says "90". are you going to withhold D50 or glucagon or instaglucose ? No, you treat the patient --- and by giving narcan i am treating one of the most likely problems for this patient who is critical, in the absence of any more facts that might change my mind -- I can only go by what i have been told so far. This could change.
ERDoc Posted November 22, 2008 Posted November 22, 2008 I would disagree with you on giving the pt you describe a bolus of D50. Stroke can mimic hypoglycemia and if you give a huge sugar bolus you can cause necrosis of the tissue around the stroke area. The best thing to do for a stroke pt is to keep them euglycemic. Don't hold too strict to the treat the pt not the monitor mantra. Treat the pt and the info that you have. Again, I would not be giving this girl narcan unless I had better info. She already has some secretions that will impact her breathing. Do you want to put her in flash pulm edema and make things worse?
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