DFIB Posted October 2, 2012 Author Posted October 2, 2012 (edited) So the police arrive and do a walk through. the patient is not armed and the only visible guns are the ones already mentioned. The wife makes no verbal objection, only an exasperated look, to placing them in a gun cabinet that is against the wall beside the TV. "Please, please help my husband" she says. The scene is clear. Edited October 2, 2012 by DFIB
Happiness Posted October 2, 2012 Posted October 2, 2012 (edited) I would like to know all the history of the evening, vitals, and exactly what my pt looks like for example is he pale and sweaty etc. and what drugs or etoh may have been ingested in the last 48 hrs. including regular meds Edited October 2, 2012 by Happiness
island emt Posted October 2, 2012 Posted October 2, 2012 That was sarcasm. Although, I actually would continue to enter being hyper vigilant of the scene. Then again, I don't deal with a lot of military vets with PTSD around here either. I've been in scenes before that had guns involved...only been shot at once. Early on in my career we were called to a third floor walk up railcar type apartment for a stabbing. It was located in the lower end of Holyoke Mass in what would be called a ghetto by most. PD was on scene and advised scene was safe and for us to come up. After toting our gear up 3 storied we entered through the kitchen door and started down the hallway towards the living room where the pt was lying on the floor. About halfway down the hallway a door at the end opened up & out popped the assailant with a tech 9 in his hands. As we turned to run the cop who was leading us in starting running and knocked my partner & I both over as he ran to clear the hallway. Shortly after the sound of a full auto 9mm was heard and bullets were spraying the walls & ceiling over our heads as we crawled into the kitchen. So much for PD clearing the scene. Luckily for us the drug dealer with the tech 9 was a lousy shot and emptied his magazine into the apt instead of us. The cops shot him and now we have two critical pt's and two scared shitless EMT's. Pt # 1 has a 8 inch kitchen knife sticking out of his chest and pt # 2 has four GSW's to the chest & abdomen. In the end both of them died by the time we got to the emergency room . Could have been us and the cops. That call made a believer out of me and even if law enforcement is on scene, I still trust my spidey sense of where I'm going to take a risk. Defibs call send my spidey sense running in the opposite direction for the moment.
Arctickat Posted October 2, 2012 Posted October 2, 2012 My experience as a shooting target isn't nearly so exciting as yours. We were called to a residence for chest pain and as we pulled up, in a low roof ambulance with a light bar on top, a figure stepped out of the doorway onto the porch and levelled a shotgun at us. We had just enough time to duck before our light bar essentially disintegrated. Then we hear this guy yell at us, "Sorry boys!! I thought you were the cops! Come on in!!" We backed out of the driveway to the road and waited for him to reload prior to the arrival of police.
emtdennis Posted October 2, 2012 Posted October 2, 2012 Assuming the scene is now safe, can we talk about the patient? Scene shows possibility of recent alcohol consumption, (the books and guns on display are moot at this point, since the police have declared the scene safe). If the pt inflicted bodily harm via gsw, the police would have told you. So far I am led to believe the situation is medical rather than trauma.
DFIB Posted October 2, 2012 Author Posted October 2, 2012 (edited) We follow the lady down the hallway. As you enter the room you can see in the light from a lamp on the nightstand a find a clean and well kept bedroom with a middle aged white male laying on a king sized bed. He is covered with a sheet from the waist down. From the bulges, or lack of you can see that he is a left leg amputee. A beam of light is shining through a slightly opened door to an adjacent bathroom. His heavily muscled chest and shoulders are covered in sweat .... The patient is restless and nauseous with a pounding headache. His face is flushed, his vision is blurred. The patient presents nasal congestion. His skin presents red blotches and goose bumps. SPO2 94 BP 240/138 Pulse 40 Temp 99 degrees Fahrenheit Medications Bayer Aspirin .81 mg, Viagra .25mg, L-arginine 6 grams Edited October 2, 2012 by DFIB
island emt Posted October 3, 2012 Posted October 3, 2012 (edited) So he takes a low dose ASA for heart health. Viagra for ED and L-arginine for ??? L-arginine is used for heart and blood vessel conditions including congestive heart failure (CHF), chest pain, high blood pressure, and coronary artery disease. L-arginine is also used for recurrent pain in the legs due to blocked arteries (intermittent claudication), decreased mental capacity in the elderly (senile dementia), erectile dysfunction (ED), and male infertility. Some people use L-arginine for preventing the common cold, improving kidney function after a kidney transplant, high blood pressure during pregnancy (pre-eclampsia), improving athletic performance, boosting the immune system, and preventing inflammation of the digestive tract in premature infants. L-arginine is used in combination with a number of over-the-counter and prescriptionmedications for various conditions. For example, L-arginine is used along with ibuprofenfor migraineheadaches; with conventional chemotherapy drugs for treating breast cancer; with other amino acids for treating weight loss in people with AIDS; and with fish oil and other supplements for reducing infections, improving wound healing, and shortening recovery time after surgery. Some people apply L-arginine to the skin to speed wound healing and for increasing blood flow to cold hands and feet, especially in people with diabetes. It is also used as a cream for sexual problems in both men and women. How does it work? L-arginine is converted in the body into a chemical called nitric oxide. Nitric oxide causes blood vessels to open wider for improved blood flow. L-arginine also stimulates the release of growth hormone, insulin, and other substances in the body. Lets start with a little more hx of events leading up to tonights call. What started the problem? How long has he had the blotching / rashes? what percentage of Body surface? What health problems besides the amputation? Is he septic from recent surgery to limb? My brain says he probably took something else that is interacting with his viagra & the ETOH. How is he presenting chest pain SOB? Radiating? !2 lead shows? Lung sounds by auscultation? No pain meds prescribed for amputation? No anti depressants? No beta blockers ? No statins? Next up! Edited October 3, 2012 by island emt
DFIB Posted October 3, 2012 Author Posted October 3, 2012 (edited) This narrative is probably going to wrap up this scenario pretty quick. The wife whose name is Sherri is home on leave from the military. She has only been home a few hours and has been looking forward to spending some quality time with her hubby Dan. Dan has been anxiously waiting for her to return all week. He was never really comfortable with her joining the military but has always loved her and respects her decisions. Ever since his truck accident 5 years ago, Sherri's absence is almost unbearable. Dan was hurrying home after a long day at work because Sherri was returning from a tour of duty in Iraq when he fell asleep at the wheel and rolled his truck. After a prolonged recovery his only permanent injury is a T-3 spinal cord injury and the amputation of his left leg. Sherri still has nightmares about Iraq but dan works hard at understanding and helping her. In preparation for his honey's arrival Dan chills a bottle of Merlot (Sherri's favorite) and mows the lawn. He really wishes he cold trim the hedges but they are just a little out of his reach. After a dose of L-arginine and a quick trip to the gym he comes home, He is grateful for the good health he has enjoyed despite his injury. takes a shower and removes his Foley and takes a Viagra. Sherri arrives home at around 2100 hrs. Takes a shower and gets dolled up while Dan has a couple of drinks and cleans her weapon for her. They always enjoy going to the range together and he is looking forward to spending some time shooting with his wife. Sherri doesn't even have time to finish her glass of wine before Dan entices her into down the hall and into marital bliss. As they begin to have intercourse the crisis begins. It was the craziest feeling he had ever had . Lets start with a little more hx of events leading up to tonights call. What started the problem? How long has he had the blotching / rashes? what percentage of Body surface? What health problems besides the amputation? Is he septic from recent surgery to limb? My brain says he probably took something else that is interacting with his viagra & the ETOH. How is he presenting chest pain SOB? Radiating? !2 lead shows? Lung sounds by auscultation? No pain meds prescribed for amputation? No anti depressants? No beta blockers ? No statins? Next up! The blotches are of sudden onset and cover most of his body but seem worse in chest and shoulders. He is in relatively good health in spite of his T-3 injury and amputation. Works out regularly and is in great cardio shape. No chest pain. Sinus Bradicardia at a rate of 40 Lungs are clear. HE took pain meds for a while but has discontinued for about 4 years now. Occasional Advil or Tylenol but not today. Dan does not take antidepressants. He shared some of Sherri's Lexapro for a while about three years ago but swapped them for hard workouts. Dan does not take beta blockers or statins He is really anxious and short of breath. As you work over him he gasp "Please help me, I feel like I am going to die" Do you think the L-Arginine could potentate the effects of Viagra? EDIT Spelling Edited October 3, 2012 by DFIB
DFIB Posted October 3, 2012 Author Posted October 3, 2012 Additionally Dan is sweating profusely above T-3 and cold and clammy below.
Eydawn Posted October 3, 2012 Posted October 3, 2012 Well hell. Foley? Removed? Sweating? High pressure? Autonomic dysreflexia. Sit his ass upright! Get the Foley back in! Urinary retention is probably the issue... OR, it could just be from the sexual stimulation. Regardless, elevate the head and let's get moving to the hospital. Also, why is this gent using an indwelling Foley instead of intermittent clean-cathing self? Just curious. Good scenario (dragged out WAY too long) challenging our assumptions... everyone assumed the husband was the war vet, that the alcohol and guns indicated a PTSD exacerbation. Moral of the story? Ask more questions. Direct questioning is important! Wendy CO EMT-B RN-ADN Student 1
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