RaceMedic Posted April 18, 2006 Posted April 18, 2006 OK Pulse motor and nueral functoin present below the fracture? slpint in position found. C collar long spineboard head blocks, O2 @ 15lpm IV's running TKO or KVO ( whatever) after a 250cc bolus and reassess BP. Fix dizzyness also? Ask son .. find the bottle with little yellow pills in it for his heart and bring it to me. What is it? NO pain management until Head trauma from a 15foot fall can be ruled out positivly ( sorry don't carry entonox) not familiar with it. besides im an I in this case correct? i can not give meds where i am as an I EKG for sure. What does it show?
Guest Posted April 18, 2006 Posted April 18, 2006 O2 via NRB 15 L. Bout freaking time! Initial sats.....89% on .21 "lying on top of debris" could mean a million little hidden things underneath him. Any obvious bleeds? NO! Is the 2nd kneecap above of below the first one (in other words, is this a deformity in the femur area or tib/fib). # L FEMER!!!!!!! decreased pedal and dorsal pulses, foot cool to touch. Assuming 02 therapy started with no obvious bleeds I'm gonna let the Medic do the ALS thing (i.e., determine if pain mgmt meds are advisable with those vitals...esp BP, start the line(s), etc) and I will do the BLS thing. Kevkie can't be found......! Its still your call your not off the hook yet! Let's cut and expose to see if anything else has holes in it/is pointed the wrong way/otherwise damaged etc. As mentioned above I want to get a look at the posterior sections in particular. Good, EXPOSE it! I'll ask quickly why he is on heart meds. This may/may not help explain the lung sounds and/or why he fell. I'll also ask if he is a diabetic. Maybe a BGL check to explain why he fell/why he is "dizzy" right now. Sugars fine! no PMHX of Diabetic. Review please does he have or have not a Cardic history? you tell me! Let's grab some towels and build up the space under (and stabilize) that leg. If it's a femur injury then I might pull manual traction now and ask the medic to go get the traction splint. And while you are at the truck could you grab some cold packs, board splints, pillows and cravats? I dunno how we are going to stabilize this limb yet given the scenario but we do want to get moving quickly. Bloody Brilliant! And where did You find that Avatar? Will you use Entonox? no open wound over # L femer, Mid shaft,
MedicRN Posted April 18, 2006 Posted April 18, 2006 Yellow vision = dig toxic. What does the EKG show (prob. a-fib <50)? What is BP? Consider fluid bolus. Consider TCP. Oh yea..... and all the other spinal/extremity immobilization stuff mentioned as well as high flow O2 and lg bore IV NS or LR TKO for now.
Beagle189 Posted April 18, 2006 Posted April 18, 2006 OK, we got him on O2, and immobilizied. Since he can't remember the medication names he is on I'll recite some beta- blocker names for him to see if any are familiar and put him on ECG. What does he and the ECG say?
Guest Posted April 18, 2006 Posted April 18, 2006 OK Pulse motor and nueral functoin present below the fracture? slpint in position found. C collar long spineboard head blocks, O2 @ 15lpm IV's running TKO or KVO ( whatever) after a 250cc bolus and reassess BP. Fix dizzyness also? Ask son .. find the bottle with little yellow pills in it for his heart and bring it to me. What is it? NO pain management until Head trauma from a 15foot fall can be ruled out positivly ( sorry don't carry entonox) not familiar with it. besides im an I in this case correct? i can not give meds where i am as an I EKG for sure. What does it show? Ok today you have Entonox! Do you want to use it, this is still BLS senario....at this point. te he. Spinals complete, IV bolus in. Leg splinted with Sager improved circulation to distal Pulses, foot is now pink. for fun you use Pulse ox and the big toe has a SaO2 of 93%. BP: 110/ 68 RR 28 SaO2 94% Monitor shows in Lead 2 regular rhythum, rate 62, PR interval bit long?????? Any one whats Normals for PR interval, What could this be, Pretty slow rate for a Guy that is Shocky? :twisted: :twisted: :twisted: :twisted: :twisted: :twisted: FINALLY the Paramedic shows up, He had to go pee? Loading in the truck now.....want this to get tougher. It will! Son comes back, on Lasix (little yellow one) And a pill that comes from the Foxglove plant>>>>>WTF? and a Blocker something? Now You tell ME! Are we having Fun Yet?
Guest Posted April 18, 2006 Posted April 18, 2006 MedicRN"]Yellow vision = dig toxic. What does the EKG show (prob. a-fib <50)? What is BP? Consider fluid bolus. Consider TCP. Yellow vision = dig toxic. Yes indeed! 1000 % Why did he fall again? Could that be a possible answer? Borderline 1 degree block, please help me out here, could you explain? whats norms for PR again I think I forgot? DAMN IT, THE Tires Flat on the truck......What next?
RaceMedic Posted April 18, 2006 Posted April 18, 2006 Sons along in the truck. Did he bring the pill bottles? You are wanting the entonox too much .. i will hold off for now...LMAO :twisted: B/P is improved .. but what about the dizziness? What kinda blocker? read the bottle please? Why is he taking herbal suppliments? has he taken either of the new found meds today ? Is he on a K+ replacement with the Lasix? Slow rate so possibly has taken the blocker or has decreased K+
Guest Posted April 18, 2006 Posted April 18, 2006 Sons along in the truck. Did he bring the pill bottles? You are wanting the entonox too much .. i will hold off for now...LMAO :twisted: B/P is improved .. but what about the dizziness? What kinda blocker? read the bottle please? Why is he taking herbal suppliments? has he taken either of the new found meds today ? Is he on a K+ replacement with the Lasix? Slow rate so possibly has taken the blocker or has decreased K+ Ok: You may need a shovel soon, you lead me your toast! Son is helping Kevin fix the tire. Entonox is NOT contraindicated.....take away the pain when puting on Traction why not? Pain is now 5/10 Kevin found his glasses! Tenorminin (Atenolnol) all blockers........ end in LOL! no Joke! Taking meds as Prescribed, his MD is older than him. Slow rate ask RN MEDIC! Hes in the truck now supine, starts to C/O SOB, let me up please I can't breath! More Questions? Be carefull what you ask for? :twisted: :twisted: :twisted: :twisted: :twisted: :twisted: :shock:
rocket Posted April 18, 2006 Posted April 18, 2006 Yellow vision and a pill from the foxglove plant? Sounds like Digoxin overdose to me. I'm just a basic so I'd whip out that tattered old copy of Jems that somehow made its way from the mens' room at the station to the door pocket of the ambulance, thumb through it 'till I found this article: http://www.jems.com/jems/23-8/13172/ And then hand it to the medic for reference while I go figure out what to do about that flat tire..... -Trevor
MedicRN Posted April 18, 2006 Posted April 18, 2006 Yellow vision = dig toxic. Foxglove = Digitalis purpurea Yes indeed! 1000 % Why did he fall again? Could that be a possible answer? I'd speculate he has some sort of cardiac event (3rd degree HB maybe) causing syncopy. Since he is also on Lasix, I'd love to know what is potassium level is (especially if he's not taking potassium replacements). Borderline 1 degree block, please help me out here, could you explain? whats norms for PR again I think I forgot? PR norms are 0.16-0.20sec 1 degree = PR > 0.20sec (one big box on the monitor paper) DAMN IT, THE Tires Flat on the truck......What next? About the only thing to do is treat symptomatically as an ambulance typically does not carry Digibind.
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