80 year old female collapses

[musicislife]

You are in the store when an 80 year old woman suddenly collapses. No one catches her.

Actions: Have cashier or anyone who is around call 911

Consider head stablilization

Airway, Breathing, and Circulation are present

Pulse is weak, rapid, and regular

Breathing is regular and adequate with no noise

Airway is unobstructed by any foreign objects

Skin is pale and dry

Maintain open airway using jaw thrust manuver

Elevate legs using box or shopping basket to treat for possible hypotension

Monitor breathing

Start compressions/rescue breathing should it become necessary

Ambulance arrives and takes over the scene

I used the jaw thrut because the probability of someone hitting their head on the floor in the situation (since she was not caught) is high, and I want to ensure that the spine remains intact

I know this is insanely simple, but ive been thinking a lot about unresponsive patients and being a lay rescuer (my town doesn;t use First Responders like me )lately...so I want to make sure I have my thoughts in order.

Edited June 8, 2012 by musicislife

[nypamedic43]

I wouldnt elevate the legs unless you are sure the patient is hypotensive...that means checking a blood pressure. If the patient is breathing fine there is no reason to do a jaw thrust. Maintain c-spine and monitor until the ambulance gets there.

Is the patient now awake? If so, get a SAMPLE history and ask them what happened. Think about WHY a person would have a syncopal episode. Do they have a cardiac or diabetic history. If it IS a simple syncopal episode, thier pressure should recover to normal fairly quickly.

You will find that unresponsive patients are fairly uncommon and usually happen because of a medical condition. Diabetics, cardiac conditions, overdoses come to mind. Just remember to stay within your scope of practice.

[ERDoc]

I think that since the pulse is weak and rapid we can assume some degree of hypotension. The problem with elevating the legs (a form of Trendelenberg) is that is doesn't actually do anything. I agree with NYPA, if the pt is breathing without any difficulty there is no need to do any sort of airway maneuvers. There is no such thing as a simple syncope in an 80y/o.

[nypamedic43]

I agree with you Doc..thats why I would ask about medical history and if the patient is now awake, how they felt before they passed out.

[DFIB]

By performing some simple exploratory procedures you might can find some clues that can help you, Are there any DCAP- BLT on her head? What do her pupils look like? Are they PEARL? Skin tugor? Color and condition of mucosa? Is the mucosa moist and pink? Is it pale? Dry?Are there any signs of hemiplegia or hemiparesis? Did anyone see what exactly happened? Does she have JVD? Edema in arms or legs? Among a ton of other stuff you can look for.

All of these things are can lead you to clues as to what this lady has but without diagnostic tools you will not be able to really know what is going on.

By maintaining her airway and waiting for the Ambulance you are ahead of the game.

EDIT: If you are doing the jaw thrust maneuver you will know when she wakes up from the moaning. Left lateral recumbent might be a better position while waiting

Edited June 8, 2012 by DFIB

[musicislife]

By performing some simple exploratory procedures you might can find some clues that can help you, Are there any DCAP- BLT on her head? What do her pupils look like? Are they PEARL? Skin tugor? Color and condition of mucosa? Is the mucosa moist and pink? Is it pale? Dry?Are there any signs of hemiplegia or hemiparesis? Did anyone see what exactly happened? Does she have JVD? Edema in arms or legs? Among a ton of other stuff you can look for.

All of these things are can lead you to clues as to what this lady has but without diagnostic tools you will not be able to really know what is going on.

By maintaining her airway and waiting for the Ambulance you are ahead of the game.

EDIT: If you are doing the jaw thrust maneuver you will know when she wakes up from the moaning. Left lateral recumbent might be a better position while waiting

thought you werent supposed to do that for suspected trauma? And cant an unresponsive patients tounge end up obstructing the airway?

[paramedicmike]

thought you werent supposed to do that for suspected trauma?

What do you do for each and every single patient you come across? What are the first three things you take note of and maintain?

If you have a trauma patient with a compromised airway are you just going to leave that person there? Even if a simple maneuver might resolve the complication?

And cant an unresponsive patients tounge end up obstructing the airway?

Can it? What does your research show?

[DFIB]

thought you werent supposed to do that for suspected trauma?

Would you consider that an 80y/o woman that falls from her own height may have an index of suspicion for trauma? What are her possible mechanisms of injury? What might have caused her to fall in the first place? Do you really know what happened?

And cant an unresponsive patients tounge end up obstructing the airway?

What positions are indicated to alleviate the tounge blocking the upper airway?

Edited June 8, 2012 by DFIB

[musicislife]

I would say that the index of suspicion comes from the fact that she collapsed and hit her head, without anyone catching her. I would use the jaw thrust due to this index of suspicion. Another possibliliy is the recovery position, but I am not inclined to do that due to my index of suspicion. Also, the age of the woman, indicating a possibly more brittle bone structure, also raises my suspicion of head neck or back trauma.

According to my book, unconscious patients often have their airways obstructed by their tongue, and the jaw thrust (among others as well) will alleviate this.

Frist three things are Airway, Breathing, and Circulation (C-Spine is also there, as part of the scene size up)

[DFIB]

I would say that the index of suspicion comes from the fact that she collapsed and hit her head, without anyone catching her. I would use the jaw thrust due to this index of suspicion. Another possibliliy is the recovery position, but I am not inclined to do that due to my index of suspicion. Also, the age of the woman, indicating a possibly more brittle bone structure, also raises my suspicion of head neck or back trauma.

According to my book, unconscious patients often have their airways obstructed by their tongue, and the jaw thrust (among others as well) will alleviate this.

Frist three things are Airway, Breathing, and Circulation (C-Spine is also there, as part of the scene size up)

Very good. You have identified your index of suspicion and opened the airway. Are you going to hold the jaw thrust maneuver until the ambulance arrives? If you use the modified version you can stabilize her cervical spine as well, since that is your suspicion.

Edited June 9, 2012 by DFIB