For the medics, how would you triage this medical patient?

[PRPGfirerescuetech]

Dispatched: Unknown Medical

Arrived to find a 34 year old female, alert and oriented, complaining of new onset dizziness. Began 5 minutes prior to 911. Denies any other medical or traumatic malady.

PMHX: None

Meds: None

Allergies: Ragweed

Exam:

Neuro: Without noted deficits

SKIN: Warm/Pink/Dry

Head: Benign

Face: benign

Airway: Patent

Neck: Benign

Chest: Benign

Lungs: Equal all fields

Abd: SNT all quad

PELVIS: Benign

EXT: Good ROM, weight bearing with normal gait

Vitals:

124/82, 84, 14, 99%, LS clear and equal, Pupils EnR

Your the medic on a limited mic unit on a semi-urban enviroment, with the patient in a large park area.

Do you triage this patient ALS and ride it in? Or triage to your EMT, and drive happily to your locaL ED, singing happily to your kumbyah self for gleefully avoiding a chart?

Please reply with what would you do and an explanation of why?

XoX, PRPG

[RaceMedic]

Before i would pass of to my EMT and gleefully sing to myself, i would like to know what my monitor says and possibly a finger stick. but chances are i would go ahead and ride in back. But also she is in a park right ? is there ragweed around ? has she taken an alergy pill recently? is it one she has taken before ? or is it new ? or a new script ?

Also in a case like this it really depends on how much i trust my EMT as to whether or not i let them in the back with a PT alone.

Be Safe

Race

[medic429]

I agree with Race. I'd probably ride it in.

I too would want a finger stick and monitor. And I'd try to get a little more out of her...is it true vertigo or is she lightheaded? Any recent head trauma? What was she doing when the "dizziness" occurred? Any other info??

[rocket]

The PE isn't particularly telling so beyond adding a FS BGL check I'd want to know more about this new onset dizziness. An alert and oriented patient is a great resource for figuring out what is going on.

I'd like you to tell me a little more about what made you call EMS.

Describe what you are feeling right now.

Describe what you felt before you called.

Any change in how you are feeling between then and now?

Have you ever experienced anything like this before (and if so what happened)?

What were you doing when this occurred?

What have you been doing today?

Yesterday?

How about meals/fluids for the past 24 hours or so?

Any chance you may be pregnant?

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This scenario is one where the overall presentation of the patient (agitated, etc) probably tells the most about the situation. Unfortunately this aspect of the scene is hard to communicate in a post.

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I'd say about 50% of medics I've dealt with would have me take the patient in BLS and the other 50% would ride it in.

-Trevor

[Mediclcems]

I agree with all of the above. Definately want to see the monitor. BGL. Does patient have nystagmus?

ALS all the way, if for nothing more than to CYA.

[Acosell]

OPQRST, CBG, ECG, then decide from there.

[AZCEP]

New onset dizziness has too big a differential to allow BLS to transport if an ALS provider is available.

Good possibility it is a fairly benign issue, but we are here, we have nothing better to do. Transport ALS.

[nsmedic393]

Once a complete physical assesment has beed completed, including BGL and ECG and there is sothing I am going to be able to do differently than my BLS partner than I'm gonna drive in and let my partner attend. As it stands now the only other thing the patient may need is a IV lock.

I'm only a few feet away and my partner is perfectly capable of screaming at me if something goes wrong.

[PRPGfirerescuetech]

Her responses:

Describe what you are feeling right now. "Dizzy"

Describe what you felt before you called. "Dizzy, duh"

Any change in how you are feeling between then and now? "Dizzy. Are you new or somethin?"

Have you ever experienced anything like this before (and if so what happened)? "Nope, never"

What were you doing when this occurred? "Sitting on my couch, watching me some TV"

What have you been doing today? "Bit of housework in the morning, relaxed til then. Nothing real strenuous"

Yesterday? "Work, dinner and some laundry. Nookie with the husband and a good nights rest"

How about meals/fluids for the past 24 hours or so? "Normal food and drink, full meals, eatin and drinkin good"

Any chance you may be pregnant? "Nope, got me tubes tied after my 12th kid. Dont want to have unlucky number 13, ya know?"

For the new posters, take this information into consideration whenh posting.

To all, remember, im looking for why you would triage the patient the way you would....whats the reason.

[PRPGfirerescuetech]

Denies recent falls or head trauma, no head, neck, or back pain. Neurological assessment proves normal. No signs of CVA/TIA, pupils E/R, patient when questioned defines the prioblems as "Im dizzy!, im not lightheaded, im not nauseated, im dizzy! Thats it, yo."