ALS or BLS

[PRPGfirerescuetech]

43 year old B/F, on the 2nd floor of her residence in a rather affluent neighborhood, alert and oriented, complaining of moderate hemmoraging.

Patient began her at home dialysis treatment in her brand spanking new R arm skin graft, finished her treatment, and hemmoraged significantly (1200-1500 cc's) of a rather thin looking blood (lotsa heparin).

c/o "lightheadedness" which seems to change orthostatically. Supine in chair 134/88, 84, 99% ; Seated 126/84, 78, 98%; Standing 118/78, 76, 99%

Hx: RF, HTN

Meds: unsure

Allergies: PCN

Skin: clammy

PN: all but chief complaint.

Reports normotensive pressure 140's/90's

This go ALS or BLS? Explain your position.

XOXO, PRPG

[Eric]

i say BLS for if she stable then lets go code 1 no l/s just take her to the ER

[Savoy6]

43 year old B/F, on the 2nd floor of her residence in a rather affluent neighborhood, alert and oriented, complaining of moderate hemmoraging.

Patient began her at home dialysis treatment in her brand spanking new R arm skin graft, finished her treatment, and hemmoraged significantly (1200-1500 cc's) of a rather thin looking blood (lotsa heparin).

c/o "lightheadedness" which seems to change orthostatically. Supine in chair 134/88, 84, 99% ; Seated 126/84, 78, 98%; Standing 118/78, 76, 99%

Hx: RF, HTN

Meds: unsure

Allergies: PCN

Skin: clammy

PN: all but chief complaint.

Reports normotensive pressure 140's/90's

This go ALS or BLS? Explain your position.

XOXO, PRPG

What's the transport time? Has the bleeding been stopped prior to arival or is she actively bleeding? What are the capabilities of the on scene crew, if BLS will waiting for ALS be too long?

Since starting an IV on this patient opens the chance of another bleeding site, why??If as you say, lotsa heparin. Plus What fluids and why?? What will a crystalloid accomplish and if too much, hey she has kidney problems, right??

A good BLS crew could transport this pt. O2 supine, monitor( I don't mean EKG or any other machine) the old fashioned clinical skill of monitoring a patient with your eyes, ears, nose. Cave man stuff

[PRPGfirerescuetech]

limited MICU ALS unit, EMT / Paramedic. Either the medic drives and the basic techs the call, or the medics techs the call and the basic drives.

Anticipate a ten minute transport time.

Keep in mind, im not bartering an opinion, just curious of yours (collectively)

[Savoy6]

limited MICU ALS unit, EMT / Paramedic. Either the medic drives and the basic techs the call, or the medics techs the call and the basic drives.

Anticipate a ten minute transport time.

Keep in mind, im not bartering an opinion, just curious of yours (collectively)

Without having seen before, I still say BLS

I advocate letting Basics attend whenever possible. And this is one of those.

[Ace844]

ALS

[TechMedic05]

43 year old B/F, on the 2nd floor of her residence in a rather affluent neighborhood, alert and oriented, complaining of moderate hemmoraging.

Patient began her at home dialysis treatment in her brand spanking new R arm skin graft, finished her treatment, and hemmoraged significantly (1200-1500 cc's) of a rather thin looking blood (lotsa heparin).

c/o "lightheadedness" which seems to change orthostatically. Supine in chair 134/88, 84, 99% ; Seated 126/84, 78, 98%; Standing 118/78, 76, 99%

Hx: RF, HTN

Meds: unsure

Allergies: PCN

Skin: clammy

PN: all but chief complaint.

Reports normotensive pressure 140's/90's

This go ALS or BLS? Explain your position.

XOXO, PRPG

ALS.

Borderline orthostatic [but going to assume so based on BP. Pt. may be on B-Blocker, skewing HR results], clammy skin, and lightheadedness [with the orthostatic changes] is ALS for me. I'm typically a rather conservative Medic when I triage to BLS. Honestly, it doesn't happen all too often where I currently work - It was easier in clinicals where there was a lot less true 'ALS' calls. I would not feel comfortable triaging a complicated medical patient [Renal Failure] who has an active, legitimate, ALS complaint. This isn't a bash against any BLS crew - but it's what gets me in trouble because I don't 'triage down enough' - so they say. [small, not busy service that's semi-rural...BLS wants everything triaged to them.]

Tech

[itku2er]

als all the way........

[AZCEP]

How much does she weigh?

Knowing this will allow us to determine which stage of shock we are dealing with.

Guessing the standard 70 kg for weight, I'm figuring ~20% blood loss. This amount is the dividing point between class 1 and class 2. The lack of tachycardia is a bit concerning. Why is she unable to compensate?

Definitely ALS.

[paramedicmike]

PR:

If this were you and me on a truck I'd take it. Blood loss, a rate in the 70s, some BP changes on position all post dialysis would have me just slightly concerned. Even if this were a larger patient I'd still be concerned with the blood loss and lack of a tachy rhythm.

Did I miss it? You mentioned a complete treatment. How long was she hooked up?

And do I really have to guess with whom you were working on this call? I can guess, you know. In fact, I have a pretty good idea of who it might've been.

And let me guess further, she had you take it.

-be safe.