DartmouthDave Posted March 17, 2012 Posted March 17, 2012 Hello, You are dispatched to a well kept suburban house. On arrivial you meet with the police and the patient's mother. She says she hasn't seen or spoken to her daughter or baby for three days and she is worried. The police open the door and you enter the house. You find a 28 year-old women laying prone on the kitchen floor and the house smells of urine. Cheers....
Richard B the EMT Posted March 17, 2012 Posted March 17, 2012 Once determining that the patient you see has a pulse, and is breathing, you or your partner starts running vitals on her, and the other joins the LEOs in looking for the baby. If the baby is found, as with the first found victim, start running vitals.
Lytefall Posted March 17, 2012 Posted March 17, 2012 Scene survey. What do we see? Anything suspicious? Odd? Signs of a struggle? Trauma to the victim? Empty alcohol or pill bottles? Vomit? Anything to indicate a definitive length of time she's been in this position (how many newspapers in mailbox etc.). Cspine control and packaged just in case. Vitals and a blood glucose as well right off the hop. What are the vitals? Temp? Sent from my iPhone using Tapatalk Also, how far post partum are we talking? Possibility of post partum depression for explaining missing child or pp complication for mothers state? Sent from my iPhone using Tapatalk
Kiwiology Posted March 18, 2012 Posted March 18, 2012 Do a quick primary survey - if no respiration or pulse I'm going run a rhythm strip and sign the life extinct certificate right there
DartmouthDave Posted March 18, 2012 Author Posted March 18, 2012 Hello, The home is clean and well kept. There is no sign of a struggle or empty alcohol or pill bottles. The patient is in the prone position. You roll her over. She is breathing at a rapid and shallow rate in the high 30's. Their is dried emesis on her face, floor, and clothing. Her skin is cool to the touch and their is a weak but rapid radial pulse around 150 or so. In addition, you note dried urine on her pants and the smell of stale urine in the air. The patient is attached to the monitor. EKG: Sinus Tachycardia @150 BP: 84/30 Resp: 38 SpO2: 87% The patient's mother and the police look around the house and they find the 4 month-old infant upstairs in the crib. The police say the baby looks 'sick'. Cheers
Kiwiology Posted March 18, 2012 Posted March 18, 2012 For right now mum is status 1 (immediately life threatening problem) Need back up on a 1; two Technicians will do but an Intensive Care Paramedic would be ideal Put in an LMA and ventilate, if her SPO2 improves I'm happy to manage her airway with the LMA if not I'd be inclined toward RSI however in saying that I'm keenly aware we are only a two person crew and there is another patient plus I don't know if the cause for unconsciousness will rapidly improve e.g. GHB or alcohol poisoning, post seizure. If her lungs are clear then stick in a big bore drip and give one litre of fluid as a bolus Secondary survey and a full set of observations please My impression for mum is either a neurogenic insult (e.g. stroke) or a drug overdose but possibly something environmental if we have two crook patients in the same home As for baby I'm really crappy with paeds so I'm going to be guided here more by clinical guidelines than actual knowledge ... um, general impression? work of breathing? activity? cry/grimace? a few basic obs; heart rate, SpO2, AVPU?
Cookie Posted March 18, 2012 Posted March 18, 2012 If your a two person crew and you have two patients, and one is a infant I would call for more help. If there is a possibility of anything enviromental then I would remove her and the baby from the home. Start working on them in the ambulance. Can they check the carbon monoxide levels in the home or the patients? 1
Lytefall Posted March 18, 2012 Posted March 18, 2012 Did we get that blood glucose? Any acetone breath? Mucous menbrane moist or dry? In addition to what kiwi said I think ruling out or in DKA would be a good idea. As for the baby. Not eating/nursing x 3 days would be an easy way for a baby to "look sick" Sent from my iPhone using Tapatalk
DartmouthDave Posted March 18, 2012 Author Posted March 18, 2012 (edited) Hello, Ok...Kiwi and Lytefall, Her mouth is dry and her lips are cracked and smell of acetone. Some think emesis is suctioned from her mouth. She tolerates a LMA (...or EGD of choice...) and is easy to ventilated. Her lungs are clear and her stas perk up to 93%. A large IV is inserted and a bolus is started. Her blood glucose level is 38 mmol/dL. Her mother states that she has been a diabetic since she was young a needs insulin. She also has been battling a cold for the last week. The police bring the infant to you to assess. The infant is lethargic, with flacid muscle tone. His mouth is dry and the soilded diaper is dry. The skin tents when pinched and a quick bracial pulse check shows a rapid, regular rate of 150. He is breathing 50 time a minute. Cookie.... A second ambulance is on the way as Fire First responders. Cheers!!! Edited March 18, 2012 by DartmouthDave
mobey Posted March 18, 2012 Posted March 18, 2012 What do her lungs sound like? Temp? Lets give her 20ml/kg bolus and get her to the nearest facility. Baby can have IV/IO access as well. Need a glucose here too. Baby gets a 10ml/kg bolus to start (given the sugars are not high as well). Temp? Lets give her 20ml/kg bolus and get her to the nearest facility. Baby can have IV/IO access as well. Need a glucose here too. Baby gets a 10ml/kg bolus to start (given the sugars are not high as well). EDIT: Should have read closer
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