Whatcha Gonna Do?

[triemal04]

Don't use propofol; either versed or your choice of benzo's. The fixed gaze and decerebrate posturing could easily be missed seizure activity. While a deviated gaze can happen for other reasons, in this unresponsive patient, with everything else in his presentation, treating for a potential seizure is appropriate.

To recap:

Intubate; use etomidate (or versed) and succynocholine to faciliate that. DO NOT use a long term paralytic unless the patients innate respiratory drive interfers with your ventilations.

Sedate with versed initially, think about adding in some fentanyl down the road.

Set your initial ventilations at 8ml/kg and 12/min. This is likely a patient that you will want to hyperventilate and drive down the CO2 but that can wait for a minute or two.

Reassess the BP, pulse, rhythm, 12lead, SpO2 and ETCO2, pupillary response and any response to painful stimuli after a couple minutes.

Elevating the head of the bed is a great (and often forgotten) idea.

Before you leave have someone get a better and more accurate history of the events leading up to the collapse, including the last several days, what actually happened at the start of the event, patients normal mentation, previous history, and how long was the delay between collapse and activation of 911.

This could go either way; either a primary neurologic event, probably a hemmorhagic stroke, or a very prolonged downtime with hypoxia.

[island emt]

"You are dispatched to a residence for an adult male that was witnessed to collapse spontaneously from standing position w/o prior complaint, injury, or obvious mechanism."

I'm going down the path of CVA with some opioid abuse as a chaser. Sky high BP, sudden onset collapse, posturing, LOC. Bradycardia, all point towards CVA.

Edited April 22, 2014 by island emt

[erice2592]

Everything previously stated was done on scene minus succ's. We only have Vec. Pt. was flown for neuro. Sub A bleed and introventricular obstructive bleed. Good job fellas