RomeViking09 Posted March 3, 2014 Posted March 3, 2014 Your a paramedic on a transporting ALS unit in an urban EMS system with a paramedic partner and are dispatched at 1600 on a friday afternoon to a call for a 50 y/o male with chest pain trouble speaking between breaths. Responding with you is a BLS Engine. Your closest hospital is a STEMI Receiving facility with no trauma services 10 min from the scene and your 25 min from a Level I trauma center both in normal traffic. Weather is clear and 62ºF, traffic is congested citywide. You arrive to find a 50 y/o male in a 2nd floor apartment in a tripod position, the engine arrived to the scene at the same time as you. What do you do?
Jaymazing Posted March 7, 2014 Posted March 7, 2014 ABC's, general impression, and oxygen. Let's start finding out whats going on and how it all started? If I have enough hands, I want a set of vitals and a 12-lead, too
island emt Posted March 7, 2014 Posted March 7, 2014 have the hosers carry him out of the second floor to my office after I do my initial intake and assessment along with a quick 12 while they are fetching the chair.
Just Plain Ruff Posted March 7, 2014 Posted March 7, 2014 have the hosers carry him out of the second floor to my office after I do my initial intake and assessment along with a quick 12 while they are fetching the chair. Hey Island, make sure you check him for the bends.
MedicNorth Posted March 10, 2014 Posted March 10, 2014 hmmm - Waiting on info here. Would love to see what the vitals, History, and ECG show us
RomeViking09 Posted March 12, 2014 Author Posted March 12, 2014 Sorry been busy... Scene finds an apartment with strong smell of paint fumes, patient only able to speak 1-2 words at a time. Hx- Asthma with 1 prior intubation 3 months ago and ICU admit, HTN. Meds- Albuterol MDI, Unknow name HTN med (and you can't find it on scene), NKDA VS- HR: 120 RR:30+ BP: 142/88 SpO2: 90% on room air BGL: 122 mg/dL ECG: Sinus Tachycardia with ST depression in all leads BLS crew places the patient on 15 L/min by NRB, your Paramedic partner gets an 18G in the Left hand for you Assessment LOC: A/Ox4 GCS 15 Head/Neck: Pupils PERRL, + JVD, Trachea Midline, No notes trauma or other abnormalities Chest: No noted trauma or abnormalities, Lung sounds: Bilateral wheezing in upper lobes, diminished bilater in bases, clear S1 & S2 heart tones, no noted trauma or other abnormalities ABD: Soft and non-tender in all quads, no trauma or abnormalities Extremities: + CSM x4, no trauma or abnormalities Patient unable to walk due to distress, weights 300lbs Treatment Plans?
island emt Posted March 12, 2014 Posted March 12, 2014 I'd go with a duo neb tx as long as we are waiting for the hosers to get back with the stair chair. Then lets get him out of the paint fumes that are causing the resp distress/ asthma exacerbation. Have the big strong firemen carry him down to the ground level where we get him comfortable on the stretcher in a semi fowlers and go along to the hospital. Do you have waveform capnography available? Whats his waveform look like? ETCO reading?
RomeViking09 Posted March 17, 2014 Author Posted March 17, 2014 Albuterol started (Atrovent not in the drug box), EtCO2 is 28-32 with shark fin w/treatment going. What we did: CPAP w/Neb, 20mg Decadron & 2gm Mag mixed in a 100mL bag given over 10min, PT was transported to the closer facility at his request, on arrival at the ER he was placed on BiPAP and given A&A Neb thru BiPAP and admitted overnight for observation. The fumes from the apartment below his was in fact the cause of his attack.
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