Unresponsive

[HellsBells]

Ok, had a good one today...

21 y/o male pt, working as a roofer. Its his first day on the job, started his shift @ 0830hrs, at about 1300hrs tells co-workers he feels ill and walks downstairs into the partially finshed house their working on, the temp is approx 30*C

Ten mins later a co-worker finds the pt lying on the floor supine, unconscious, no response to external stimuli, shallow irregular breathing, moaning between breaths, no signs of trauma/deformity noted...go

[Kiwiology]

Clearly he a weak bitch and the job is too much for him but he doesn't want to just say it so he is faking ...

What does primary/secondary survey and obs look like?

I am thinking thermoregulatory (heat stroke) or metabolic partic hypoglycaemia

Now my cousin never was the same again after working laying linoleum because of the glue fumes but I don't think it's roofing tar ....

[DFIB]

Clearly he a weak bitch and the job is too much for him but he doesn't want to just say it so he is faking ...

What does primary/secondary survey and obs look like?

I am thinking thermoregulatory (heat stroke) or metabolic partic hypoglycaemia

Now my cousin never was the same again after working laying linoleum because of the glue fumes but I don't think it's roofing tar ....

30 degrees centigrade is not that hot.

Did you have any medical history at all for this patient?

BP?

Pupils?

BGL?

Last oral intake?

Skin condition?

Body Temp?

Quality of mucous membranes?

Skin turgor?

Edited April 24, 2012 by DFIB

[Arctickat]

30° C is plenty hot enough to cause heat related illnesses, especially if he was in an enclosed area high in the house.

[HellsBells]

Co-worker calls father- reports no current meds or significant Hx

Bp- 78/40

Pupils- 4mm PERL

BGL- 6.4mmol/L

Has been maintaining proper hydration

Skin- Diaphoretic, warm to touch

Temp- initially 37.4*C

Mucous membranes- moist

Skin Turgor normal

oh and heart rate is 200BPM- sinus tach

[mobey]

30 degrees centigrade is not that hot.

Remember this is Canada, 30C is pretty well a "hot summer day" here. As it is spring, we are acclimatized to -30 right now.

Super stoked you are posting a scenario

What does he look like? Needle marks? overweight? scars on the chest?

Lets throw on a NRB @ 10lt, and a nice big IV. Start some fluids bolusing while we grab a 12 lead and prepare the chest for defib pads.

[DFIB]

30° C is plenty hot enough to cause heat related illnesses, especially if he was in an enclosed area high in the house.

I forget most of the world lives in cooler environments. Here 3o⁰ centigrade is a cool spring breeze. I guess in Canada it would be considered pretty warm by comparison.

Temp. outside today 36 ⁰ Centigrade. Ran a couple of miles and hardly broke a sweat.

Roofing usually goes on the outside.

What is 6.4 mmol/L in mg/dL although I am guessing 6.4 mmol/L is a little high?

SpO2?

Capnography?

ECG?

Edited April 24, 2012 by DFIB

[HellsBells]

I have no intention of translating the BGL to the weird system of mg/dl used in the USA, but rest assured 6.4mmol/L is a normal BGL.

Sp02 is 93% on room air, 100% after Mobeys NRB is applied

The ECG shows a Sinus Tach/ SVT (depends who you ask) of 200bpm, no ectopy or visible st changes.

The pt appears to have a regular body type, neither thin nor obese, no scars, or needle marks, appears healthy- with the exception of his current condition.

Never applied capnography prehospitally ( although in hindsight may have been good tool)

16G IV is started on R A/C- NaCl 0.9%- wide open, Defib pads applied to chest.

[Kiwiology]

LOL Rob 6.4mmol/l is ~120mg/dl (6c20)

Distinguishing between ST and SVT can be a pain in the ass

I have absolutely no idea but I am guessing it's heat related illness

[Happiness]

What did he eat and drink for lunch. Did he eat his lunch on top of the roof?