windsong Posted October 15, 2006 Posted October 15, 2006 Probably has an infection somewhere, that is just my thought.
brock8024 Posted October 16, 2006 Posted October 16, 2006 Ok lets do a complete trauma assessment. Head- HEENT Neck,Chest, Abd Arms, Legs Back, Pelvic V/S, Temp LOC Pulses Lung Sounds Bowel Sounds Percusion of Chest and Abd. Sample Hx or at least best we can do. What time of year is this call taking place. Summer, spring, fall, winter. We know we have our IV, O2, and monitor. If this is hypothermia it would acount for the AMS, Bradycardia, and Hypotension. I am just surprised we did not see any J waves on the EKG. I would also give some warmed O2 and IV fluids depending on how the temp is going.
zzyzx Posted October 17, 2006 Author Posted October 17, 2006 Congrats to the guys who figured this out! Yes, the patient is hypothermic. What brought him to the groung initially? He may have had a stroke, he could have slipped or fainted and hit his head, or perhaps he broke his hip. This scenario was presented years ago in my EMT class, and I like it because it tricks most people (myself included) into overlooking the most obvious things and forgetting simple BLS treatments.
ERDoc Posted October 17, 2006 Posted October 17, 2006 As one of my attendings drilled into us during residency: When you have a pt with AMS the first three things that need to be done are finger stick, pulse ox and rectal temp. Can't tell you the number of times I have seen near misses because one of these was not checked (usually the rectal temp).
Paramagic14 Posted November 10, 2006 Posted November 10, 2006 if anyone said this i missed it......but why not also take full spinal immobilization precautions since it was an unwitnessed fall,there is blood on the cold tile,lac on his head,AMS,and unknown period of down time. i know the answer is hypothermia....but what caused him to be on the floor....CVA caused the fall....trip and fall?...
iMac Posted December 16, 2006 Posted December 16, 2006 There isn't much I could have done on my end. We cant give any drugs and ALS back up in the services I work for I to distant. Not sure how close the hospital would have been in this scenario but my only option might have been to just take him there assuming its a facility that can handle a pt as such. I saw what the answer was but being from Canada and the level of care I can currently provide I'll go ahead and write out what it is I would have done.Will try not to go in to much detail. We would hold c-spine on that one. From the sounds of it we really shouldn't have it as a concern but we dent know so he wins himself a board. Would assess his airway/breathing. From info given he would require a NRB to get his sats up. At that point while I finish my circulation check and bleeds I'm going to try to get a rapid Hx at the same time from daughter.Partner can check quickly our vitals (be concerned with BGL and BP). Board him. Take bag of meds which would have been put together by daughter, throw pt in back. Re-asses ABCs/Vitals. Start my line/cardiac monitor and do my body surveys...drive fast, Done. There is nothing that I can give to this pt. Fluid bolus at this point I dont believe is warranted and if the BGL is low I would have the option of D50W. Stroke and TIA being a precaution I not being sure what is going on with this pt I would give half the dose, reassess LOC and BGL and go from there. If pt condition improved I would finish the dose, if not I would stop. Im done. Again right now with our scope I dont see myself being very useful for the poor guy, but from the looks of it urban hypothermia is part of what got this guy. Sucks to be him.
1EMT-P Posted February 25, 2010 Posted February 25, 2010 (edited) Yea, due to the incontinance I'd almost certainly say stroke/TIA. Due to interventions we can rule out Beta blocker overdose and hypoglycemia. What did the neuro exam tell us? Quick check of pupils, "doll's eye" movement, break open an ammonia amp and wave it under the pt's nose, that type of stuff. I always like to have as much information about my patients as possible, sometimes you can get clues about what may have happened. Did he have a history of CAD, CVA, Diabetes, HTN, Seizures orThyroid etc. AMI, CVA, Diabetes, Drugs, Hypothermia, Infection, Seizures & Thyroid would have been on my short list. Edited February 25, 2010 by 1EMT-P
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