iMac Posted September 26, 2006 Posted September 26, 2006 You receive a call for a 60 yo female. The call comes in as a card Unconscious/Fainting. You arrive on scene-scene safe/no hazards. Temp outside is -20/no snow tho. You find your patient unconscious in the passenger side of the vehicle with the pt's son (the only person who has been around pt)trying to seatbelt her in. He states the 3 mins it took you to get there was just too long and he was going to drive her to the hospital. woahaha....what would you like to know? :wink:
Rezq304 Posted September 26, 2006 Posted September 26, 2006 Start off with sternum rub to assess LOC. Is the airway open & pt breathing? Does she have a pulse?
Timmy Posted September 26, 2006 Posted September 26, 2006 First is there breathing or a pule? Did the pt have a history eg. Diabetes/seizures ect? Did the son hit her over the head or something? Is she suffering from extreme hypothermia? Did she crash the car? Suicide attempt from C02 poisoning? *The son should learn first aid lol.
iMac Posted September 26, 2006 Author Posted September 26, 2006 k, sternal rub done.....crunch crunch...minor facial grimace by pt. She is breathing Breathing shallow @ 6/min Pulse 78 strong/regular No Hx of diabetes/seizures LOL about the son's hitting...I did question that myself though...the patient was found unconscious in kitchen before being moved to car outside.
Timmy Posted September 26, 2006 Posted September 26, 2006 hhmmm tricky... Maybe something to do with illegal drugs or medications? lyk an OD? If she was in the kitchen, did she hit her head? Slip on a wet surface? Something along those lines? What’s her history? Meds? Allergies? ect... I know the diagnosis will be really easy lol
iMac Posted September 26, 2006 Author Posted September 26, 2006 Unknown if she hit her head. No witnesses. Hx: some minor cardiac Hx Meds: she is taking tylenol 3 (with codeine). Allergies: unknown As we moved her to our the truck we try to wake her up again. This time we get her to open her eyes but she only mumbles. A:open and clear B: 9 shallow C: 104 strong and regular BP: 116:90 BGL: 6.2 mmol ECG: Sinus Tach O2 sat:92% unassisted, goes up to 98% with NRB A/E clear times 4 (but recall the crunch crunch during the sternal rub) No JVD, No Trach deviation, NO med patches, scars, No med. alert. :twisted:
Timmy Posted September 26, 2006 Posted September 26, 2006 God i dunno lol... Got no idea what the crunch would be when you rub the sternum. Pushing to hard lol, maybe a hemothorax?? bit out there tho... She in reps distress, maybe asthma but her SPO02 ok? She’s not chocking if the airways is clear. If shes on Tylenol she’s in some sort of pain. Has she had a reaction to the med? Does she have a pace maker? Other than that I'm stumped! Is Tylenol an anticoagulant?
Timmy Posted September 26, 2006 Posted September 26, 2006 Few more questions lol Is the scaring on the chest? Is there a lump or deformity on the chest? My assessment so far: -Pt has minor cardiac history. -Pt taking Tylenol 3= analgesic for minor pain associated with headaches, operations ect. -Pt has scaring, if on chest suggesting there is a pacemaker. -Pt has Sinus Tach = elevated rate of impulses , associated with sinoatrial node which suggests pacemaker involvement. I’m going out on a limb here but scaring, operations, cardiac hx. I think it would mean there’s a problem with the pacemaker. I’m hoping lol… I’m probly no were near was’s going on but I thought I’d give it a shot.
Rezq304 Posted September 26, 2006 Posted September 26, 2006 Unknown if she hit her head. No witnesses. Hx: some minor cardiac Hx Meds: she is taking tylenol 3 (with codeine). Allergies: unknown As we moved her to our the truck we try to wake her up again. This time we get her to open her eyes but she only mumbles. A:open and clear B: 9 shallow C: 104 strong and regular BP: 116:90 BGL: 6.2 mmol ECG: Sinus Tach O2 sat:92% unassisted, goes up to 98% with NRB A/E clear times 4 (but recall the crunch crunch during the sternal rub) No JVD, No Trach deviation, NO med patches, scars, No med. alert. :twisted: Ok, any suspected trauma? If not, then pt goes straight to cot and into unit. Head tilt chin lift to open airway. Gag reflex? If not, drop an OPA. If so, drop an NPA. Have my partner assist ventilations with BVM attached to high flow Oxygen. Lung sounds? Pupils? Skin color/temperature/condition? Hook pt up to 3-lead. Rhythm?
Just Plain Ruff Posted September 26, 2006 Posted September 26, 2006 crackle crackle crackle sounds like subq emphysema or stenum fracture If subq emphysema ask history of coughing or pneumonia does she have a fever? she could have cracked a rib coughing and popped a lung and then subq emph
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