JCicco345 Posted April 3, 2007 Posted April 3, 2007 BLS unit sent out to a local residence for the fall with a leg injury. Arrive on scene to find a middle aged woman at the front door telling you "I don't know why they sent an ambulance, he just needs to go back into bed". After ascending to the second floor and making your way to the back bedroom, you find a male in his 50's sitting on the floor with his eyes open and his gazed focused forward. A quick look around the scene reveals that there are no working lights in this room, the only light is coming from the television, the floors are covered with a mix of random items, including old cigarette butts, empty beer cans, and an empty jug of wine. The matress is without any sheets or covers, and covered with what appears to be either blood or feces, its hard to see with the limited lighting. So what do you want to do and/or know. FYI: This is from a call that I ran recently, and we did not get police or fire dispatched with us, so if you think you need them just ask. I want to see how other people would have run this call.
vs-eh? Posted April 3, 2007 Posted April 3, 2007 Why did they fall? Any injury? Hurt head? Neck? Back? Chest? Abdo? Legs? N/V? Dizzy? Allergies/Med/Hx? This takes < 2 mins.
becksdad Posted April 3, 2007 Posted April 3, 2007 Well, since there was no mention of scene safety and you entered the residence to the second floor, I guess there's no problem there. But what is your initial impression of the patient as you approach? Level of conciousness/responsiveness/orientation? Respirations? Appearance of skin; diaphoretic? Pulse - rate, rhythm, quality? As well as information requested by vs-eh? And how does this impression fit in with the environment you describe (empty alcohol containers, blood and/or feces covering bed)? My first impression just from the limited verbal information is that the blood/feces could well be significant, especially if there is history of alcohol abuse. Any other clues in the environment as to pertinent history? Can wife or patient give you any further info quickly? Just based on that little bit, I'm thinking Fire would be real good to have on scene. Unless you and your partner want to carry the patient alone down from the second story, as well as equipment. It sounds like it may or may not be something pretty serious. I mean, I can get a mental image here of an alcoholic holed up in a dark bedroom, probably not eating or drinking much else, becoming dehydrated/hypotensive, maybe G.I. bleed, hell, maybe even hemmorhage of esophageal varices. Or maybe I just have a vivid imagination, and he really did just injure his leg. But this just sounds too much like one of those calls where dispatch information is way off base from the actual situation. I am curious to find out the answers to questions posed so far.
JCicco345 Posted April 3, 2007 Author Posted April 3, 2007 Unknown why they fell, the patient just remains with his gaze forward and his non-werbal, he withdraws from pain. No apparent injuries, DCAP-BTLS negative, and as i mentioned he is just sitting on the floor with his back against the bed. No info from the patient since he is non-verbal, the sister states he is baseline caox4 and was talking earlier in the day. She refuses to give us meds/hx/all because she remains saying he doesn't need to go to the hospital. At this point the sister leaves the room and dissappears.
JCicco345 Posted April 3, 2007 Author Posted April 3, 2007 Scene is safe. Inital impression was him sitting there with the straight ahead gaze, withdraws from painful stimuli, patient is non-verbal, doesn't make eye contact. Respirations are about 24/min. Skin pale and cool, non-diaphoretic. Pulse is 140, strong and regular. No other information was available from the sister. Fire was requested and dispatch, we also requested a police sgt to respond, however fire alarm informed us that it was shift change and they would try and have a sgt respond. Fire arrives within 4 minutes, no police responded.
EmergencyMedicalTigger Posted April 3, 2007 Posted April 3, 2007 Do we have a source of lighting by now-maybe from a fire guy's flashlight-so we can verify if there's blood or feces? Do we see anything else in the room we didn't notice before once we have more light? Does he have any med bottles nearby? Has he been checked to see where the blood/feces came from? BP and is he on O2?
Just Plain Ruff Posted April 3, 2007 Posted April 3, 2007 sounds like they need a housekeeper though, have that housekeeper respond code 3
JCicco345 Posted April 3, 2007 Author Posted April 3, 2007 Fire arrives on scene, and lend you one of their lights, you don't see anything else that is pertinent. Its hard to tell if there is blood in the feces, because its dried, but you believe there to be some blood mixed in with the feces. No med bottles laying around, no medical alert braclets, the patient is naked. Placed on 15 liters via non-rebreather.
EmergencyMedicalTigger Posted April 3, 2007 Posted April 3, 2007 How are his breath sounds? D-stick? Where's the sister at, will she answer any questions yet?
JCicco345 Posted April 3, 2007 Author Posted April 3, 2007 Our bls trucks don't do D-sticks. The patient is still sitting there, fire is on scene, and the sister is downstairs somewhere. She is no help.
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