Altered LOC

[scubanurse]

Since I'm bored...here goes a scenario. I have all labs and all data you could probably possibly want pre-hospitally since I took care of this patient at some point during my nursing school time.... (i.e. no possible way of violating privacy since y'all have no clue where I did my clinical times and what time frame I did them in)

Dispatch: BLS to one down in a city park, ALS available if you want it, urban city.

Arrived on scene to find 32 YOF laying in grass with shopping cart near by.

Ask away...I'm home a lot these days so I should get back pretty quickly.

[Mateo_1387]

Scene presentation - safety, weather, whats in the shopping cart? If its relevant

Patient presentation- Level of consciousness, obvious injuries, signs of distress?

Airway, Breathing, Skin color, temp, radial pulse qualities?

If she is talking then "Hi, I'm Matt with the ambulance, how are you?"

[scubanurse]

Scene presentation - safety, weather, whats in the shopping cart? If its relevant Somewhat sunny/warm day about 80 outside, scene safe, garbage bags representing the good ole homeless

Patient presentation- Level of consciousness, obvious injuries, signs of distress? The best way to describe her would be lethargic and out of it, opens eye to deep pain, no obvious injuries noted, no signs of distress other than severely decreased mental status.

Airway, Breathing, Skin color, temp, radial pulse qualities? Airway patent, snoring when she goes back to sleep but maintains well enough, skin dry, temp warm, thready and tachy pulse ~110's

If she is talking then "Hi, I'm Matt with the ambulance, how are you?"

[MariB]

Blood glucose level? Any signs of alcoholism? Rule out the obvious first . Yes I would like ALS. I always want ALS to severly ALOC

[scubanurse]

Blood glucose level? Any signs of alcoholism? Rule out the obvious first . Yes I would like ALS. I always want ALS to severly ALOC

BGL: 90

Alcoholism: several empty whisky bottles in her shopping cart but does not smell much like alcohol on her breath

ALS is on their way.

[island emt]

Any witnesses present who saw her go down?

Blood Pressure?

Any signs of drug use: both illegal or prescription?

Pupillary responces?

Any signs of trauma?

Head injury? battle signs?

Since she is an urban outdoorswoman, What is her general overall condition? clean/ filthy lack of personal sanitation? was this her campsite/home turf or just passing through

Has she been incontinent?

I'd first put a c-collar on her and move to long board just because you can't rule out injury

IV with NS and a little fluid bolus, 4 lead ECG to look for arrhythmia, if anything abnormal 12 lead.

would consider a little narcan to see if it has an effect on altered status.

With suspected chronic alcoholism would consider a coma cocktail .

I'll let others play now

[MariB]

How many layers of clothing? What is body temp?

I was doing a few at a time but island can bring us up to date lok

[scubanurse]

Any witnesses present who saw her go down? People in the park say she's been sleeping all day and not sure what's going on so they called 911 since she was an "eye sore for the park"

Blood Pressure? 158/94

Any signs of drug use: both illegal or prescription? No

Pupillary responces? sluggish/2mm

Any signs of trauma? negative

Head injury? battle signs? negative

Since she is an urban outdoorswoman, What is her general overall condition? clean/ filthy lack of personal sanitation? was this her campsite/home turf or just passing through

Has she been incontinent? Layer of grime/dirt, park go-ers have never seen her before, no ID, positive for urinary incontinent episode

I'd first put a c-collar on her and move to long board just because you can't rule out injury done

IV with NS and a little fluid bolus, 4 lead ECG to look for arrhythmia, if anything abnormal 12 lead. sinus tach on 3-lead.

would consider a little narcan to see if it has an effect on altered status. No change in mental status, but she has brief periods of combativeness but pretty weak

With suspected chronic alcoholism would consider a coma cocktail What would you give her in this "coma cocktail"?

I'll let others play now

On another note--this scenario can get as advanced as y'all want it to and we can follow her to the hospital if you want...

How many layers of clothing? What is body temp? Jeans, warmish ~ 37.9C (100.9 F)

I was doing a few at a time but island can bring us up to date lok

[island emt]

The “COMA Cocktail”

D

O

N

T

Dextrose

Oxygen

Naloxone

Thiamine

Sorry Mari: that was my 60 second eval when I got on scene.

[scubanurse]

Meehhhhh? Sugar is ok, you tried narcan and got no response, O2 I'm cool with and thiamine is great Not sure how I feel about giving D50 though...

Give me your rationale for it