Dispatched to 16 y/o F Unknown

[Dustdevil]

A single police officer arrives and is available as needed.

Excellent. He can get everybody except p3medic and I out of the room STAT.

This chick is fixin' to get nekkid! 8)

[AnthonyM83]

DIB is a "slang" abbreviation adopted in the pre-hospital arena. DIB in the ER and hospital means Disability Insurance Benefits and is found on some of the ER admission paperwork as such. SOB has faded in some areas due to medical directors and managers not wanting the charting to look offensive if SOB is taken out of context. They would then make the pre-hospital personnel write it out. So, another shortcut was created that didn't sound offensive.

For medical charting it did not make the list of approved medical terms.

There is a billing code for difficulty breathing but no abbreviation.

DOE; dyspnea on exertion, more commonly accepted now for charting and testing criteria

SOB; still recognized for both medical charting and billing codes.

Lists of accepted abbreviations

http://www2.kumc.edu/pharmacy/medabbreviations.htm

http://www.stanfordhospital.com/PDF/SHCApp...dated051305.pdf

So, you're saying there's ONE master list of abbreviations for every EMS system? If Stanford makes a change, then MiddleOfNowhere County makes the change, too? Looking at the two lists you posted, they aren't even identical...soooo how do you know DIB is a slang abbreviation? Doesn't seem that far out that a medical director didn't like SOB, so changed it to DIB...

[AnthonyM83]

sedate with versed, synchronized cardioversion.....repeat prn I'm calling it an svt with LBBB, but its semantics, tx doesn't change. she's unstable, i'm not waiting to infuse amio, she's not getting a ccb, I might consider 6 of adensosine just prior to my versed.....nurse is in for a treat!

If only LA had cardioversion....it'd be medical control for us to get an order of adenosine.

[AZCEP]

I'm with P3 on the cardioversion.

Fast/wide no specific cardiac history, I'm leaning to VT, but for now it doesn't matter.

The slowing respiratory rate and drowsiness without any treatment reason for it is a BIG problem.

Shall we say Sync at 100 joules? Versed if can be done quickly.

[CBEMT]

how bout some base line vitals?

Start the patient on 6lpm or 15lpm of o2 depending on the indication of stress.

That's it? 6 or 15?

[Dustdevil]

That's it? 6 or 15?

LOL!!

Yeah, I think I'd like to hear the rationale behind that one too!

:munky2:

[EMS_GIRL]

You said she is 16 and is 40 KG. Does the pt. have an eating disorder? I'm wondering if this is secondary problems due to bulimia/anorexia.

[sledogg1]

Ok..........this chicky is pissed off with the world and is a TCA OD........ give her the O2, IV, monitor 12 lead.......iv bolus, watch for the sz her BP is hypotensive (bolus) QRS >10MM wide complex tachy bolus 1 mEq/kg bicarb iv transport.

You don't vagal or give adenosine to wide complex..................... thats monomorphic thats amiodarone or lido then 100 j biphasic cardiovert or polymorphic magnesium 1 g iv/ lido or amiodarone 100 j cardiovert unless pulseless 200j unsync.

Like must school nurses she/ he is a twit..............

[AnthonyM83]

Or if you're an LA County FF/Medic, just BLS it to the EMTs :D

[Imagine89]

DIB is in fact "Difficulty in Breathing" sorry for any confusion....

You immediately take the paper bag off the girl's face, to which the "nurse" replies, "Why did you do that? It was making her better!" In fact, in the time since you have arrived the child breathing seemed to be slowing down and the girl seemed to be relaxing, becoming almost drowsy. Your EMT partner places the pt on 15 LPM NRB and takes some vitals as you instruct the nurse to gather any medical information about the girl. VS are: R: 30, BP: 90/60, and pulse is "too fast to feel" maybe 200 or 250 "I can't tell".

The girl is still awake, and the slightest bit drowsy, and still breathing fast with the NRB. No signs of cyanosis or retractions, though the girls is obviously working hard to breath. A little sweat is starting to form on the girls forehead, other than that skin is unremarkable.

Your EMT has a look at the pupils as you put on the pulse oximeter. Pupils are PPEARL and pulse ox reads 88%.

The nurse returns with a few copied papers and hands them to you. One is a consent to treat for emergencies, signed by the pt's parents, another is a history sheet that reads, "NKDA" and states no prior medical history. The "nurse" asks, "why don't you just take her to the hospital already? Teach her a lesson." The principal asks why you aren't listening to his "nurse".

Your squad has recently ungraded their LP 12's to the capnography function. Your partner asks if you'd like him to apply the detector under the NRB?

You ask the girl if she is allergic to anything to which she replies, "no". You ask if she has been stung by a bee or been outside, she says, "no". You ask if she has asthma, she says, "yes"........... "only"........... "when"............... "I play"................. "sports"............... After working so hard to speak, she concentrates solely on breathing, almost having to gulp for air. You ask about an inhaler and she says after a minute or so, " at home". You ask if she is on other medications and after another minute of breathing she states, "yes".................... "birth".......................... "control". You ask, "Do you smoke?" She says, "no".

The nurse says the girls was complaining of her "heart beating fast" after she heard of her failing grade. You look at the young woman and she nods her head in agreement. You ask about chest pain and she also nods "yes". And after instruction holds up 1 finger to quantify.

Physical exam reveals no DCAP-BTLS.

What next?

My guess is that she is in a state of Supra-Ventricular Tachycardia. The symptoms fit. The age fits. The criteria fits.

Has this ever happened before? Are her hands clenched?