Just Plain Ruff Posted May 18, 2015 Posted May 18, 2015 Your ALS unit from a small rural EMS base is called 65 miles into a very rural area to meet a volunteer first responder for a 5 year old black female child who is suffering from a severe headache, nausea, vomiting and right sided weakness. You have a entire drug box full of stuff (think of Kiwimedics dream box of stuff but you probably won't need it but you have it). You have a general hospital that can do a CT scan/MRI and all the requisite blood tests that is 65 miles away. Your county is about 90 miles by 90 miles Square. Yeah it's huge. You cover about 8100 square miles and your ambucab is the only one available since all the others are out on calls as well. Closest back up is 45 minutes away. You have the services of either a fixed wing aircraft that can come get your patient (they staff with a EMT-P and a Nurse but they can bring a physician if needed) and you can also get a helicopter. The pediatric facility is 190 miles away and it's top notch or you can use a level 1 adult facility that's even top notcher (if that's a word) because they do peds as well and they are 240 miles away. You also have a small rural clinic that can do basics enroute GO 1
cuffs007 Posted May 18, 2015 Posted May 18, 2015 Aneurysm, embolism? NRBFM @ 12 (15?) lpm w/suction ready to go, if needed. I'm an EMT-B, but an anti-nausea med w/fluids IV. If I'm a BLS rig, I'd first figure if an ALS meetup/transfer or helicopter would be the better bet. With a possible hour+ travel time in the BLS rig, it'd be pushing the boundaries of that golden hour. I'm leaning towards the helicopter, especially if there is a Paramedic & Nurse. I suppose it all depends on the fastest arrival time at the general hospital vs. pediatric facility. Constructive criticism appreciated. Plain ol' high & mighty attitudes need not reply.
scubanurse Posted May 18, 2015 Posted May 18, 2015 VS? Mental status compared to baseline for the kiddo, past medical hx, term baby/any complications? Has this ever happened before? How are the parents acting, any suspicion of abuse? 1
MCSOU Posted May 19, 2015 Posted May 19, 2015 Flight goes on standby when we were dispatched. Environment/scene safety? Airway? Breathing? Circulation?
ERDoc Posted May 19, 2015 Posted May 19, 2015 The pediatric facility is 190 miles away and it's top notch or you can use a level 1 adult facility that's even top notcher (if that's a word) because they do peds as well and they are 240 miles away. It's notchier but that's okay. Aneurysm, embolism? NRBFM @ 12 (15?) lpm w/suction ready to go, if needed. I'm an EMT-B, but an anti-nausea med w/fluids IV. If I'm a BLS rig, I'd first figure if an ALS meetup/transfer or helicopter would be the better bet. With a possible hour+ travel time in the BLS rig, it'd be pushing the boundaries of that golden hour. I'm leaning towards the helicopter, especially if there is a Paramedic & Nurse. I suppose it all depends on the fastest arrival time at the general hospital vs. pediatric facility. Constructive criticism appreciated. Plain ol' high & mighty attitudes need not reply. We should probably get a good history and physical before we start jumping to diagnosis. What are some questions we would want to ask the pt and the parents? What do you want to know about the physical exam? What is the indication for high-flow oxygen (or any oxygen) in this case? The golden hour is a reference to trauma and is really a work of fiction. Just because the community hospital isn't an ivory tower of medicine doesn't mean it would not be able to handle this pt. They may end up needing to transfer her, but don't count them out.
Just Plain Ruff Posted May 19, 2015 Author Posted May 19, 2015 patient is 5 years old, african in descent, parents just emigrated with her from africa appears pale Severe headache and projectile vomiting for the past 4 hours. Her mother denies any history of trauma to the head or any recent infection or vaccination, and she states that her daughter did not have a fever or chills. The mother also reports no diarrhea or signs of abdominal pain accompanying the vomiting episodes. She expresses concern that her daughter is barely using her left arm and seems to have developed a limp in her gait recently, mainly supporting herself with her right leg. The patient's mother describes pallor ever since infancy. The girl has had anemia since the age of 3 years that is being treated with iron supplements. Her mother recalls that her daughter once had swollen, painful hands at age 18 months. When asked about the family history, the mother reports that she and her husband are unrelated. She states that the patient's 6-month-old brother died of sudden infant death syndrome. Vitals are Her heart rate is 136 beats/min, blood pressure is 103/62 mm Hg, temperature is 98.06°F, and respiratory rate is 16 breaths/min. Monitor shows what you see with heart rate - no ectopy noted. 12 lead is Sinus Tach without any issues seen. The golden hour is a reference to trauma and is really a work of fiction. HOW Dare you do a full frontal assault on one of the truisms that we hold so dear in EMS Doc, you are speaking blasphemy I say, BLASPHEMY!!!!! Burn the witch!!
paramedicmike Posted May 19, 2015 Posted May 19, 2015 I can't participate because I know the answer to this. It's a decent case. Enjoy working through it.
Just Plain Ruff Posted May 19, 2015 Author Posted May 19, 2015 No not yet. It depends on where you take her if you can do that.
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