ERDoc Posted July 10, 2007 Posted July 10, 2007 Realizing that many of my most recent posts have been far from educational (unless you consider bovine bleching habits educational) so I decided to test your brains with another scenario. You are called to the residence of a 40y/o woman who was found unconscious by her son. He greets you at the door looking very upset and brings you down the hallway where you find the pt laying prone in the doorway to her bedroom. He says that he just came home from work and found her as is. She has not moved or responded to his attempts to wake her up. What do you want to know/do? (Assume the scene is safe).
brentoli Posted July 10, 2007 Posted July 10, 2007 First off, I would do a quick scan for trauma to the back. Assuming that shows negative, we would flip her to lie supine, and assess the airway. Spontanious breaths? Is there anything obvious such as pain patches inside the mouth? Does she respond to any stimulation? What are basic vital signs and what medical history can the son provide.
ERDoc Posted July 10, 2007 Author Posted July 10, 2007 First off, I would do a quick scan for trauma to the back. Assuming that shows negative, we would flip her to lie supine, and assess the airway. Spontanious breaths? Is there anything obvious such as pain patches inside the mouth? Does she respond to any stimulation? What are basic vital signs and what medical history can the son provide. No signs of trauma to the back. You flip her over. She is breathing with some gurgling at a rate of 8/min. You give her a sternal rub and she just moans a little. HR is 130, BP is 80/40. The son tells you she has a h/o hypertension, diabetes and depression.
brentoli Posted July 10, 2007 Posted July 10, 2007 Any sign of un/intentional overdose? I would attempt an NPA if the pt would tolerate it. Considering assisting respirations if they are too shallow, or any slower. I am still drawn to the consuming of pain patches. And signs of trauma to the anterior? At this point I would be loading her, and checking on the status of ALS. Looks like I am out of the game now.
ERDoc Posted July 10, 2007 Author Posted July 10, 2007 Any sign of un/intentional overdose? I would attempt an NPA if the pt would tolerate it. Considering assisting respirations if they are too shallow, or any slower. I am still drawn to the consuming of pain patches. And signs of trauma to the anterior? At this point I would be loading her, and checking on the status of ALS. Looks like I am out of the game now. Not sure exactly what you want to know as far as sign of OD. There are no pills in her mouth. No signs of trauma to the front. No pain patches in her mouth or anywhere else on her body. Pt takes the NPA without difficulty.
JakeEMTP Posted July 10, 2007 Posted July 10, 2007 Since the son stated she has a hx of diabetes, I'd do a finger stick to determine BGL. With a respiration rate of 8 per minute, I would attempt placing an ETT if tolerated and assisting with respirations at 12 - 15 /min. Her BP is low so 18g IV of NS set at KVO .
ERDoc Posted July 10, 2007 Author Posted July 10, 2007 Since the son stated she has a hx of diabetes, I'd do a finger stick to determine BGL. With a respiration rate of 8 per minute, I would attempt placing an ETT if tolerated and assisting with respirations at 12 - 15 /min. Her BP is low so 18g IV of NS set at KVO . Your BGL is 132 (you didn't think it was going to be that easy did you?). Pt gags as you attempt to do laryngoscopy. IV is started and BP remains the same.
p3medic Posted July 10, 2007 Posted July 10, 2007 I'm not too worried about intubating this patient yet. How about her GCS, neuro exam, 12ld, spo2 and etco2, what meds is she on? Any recent illness/injury? When was the patient last seen or spoken to? Thats all for now.....
EMT*Sweet Posted July 10, 2007 Posted July 10, 2007 Describe Scene (any possible MOI~~step ladders? where in room was she and what was she around) ABC's and BGL already obtained above ! Carotid pulses are present = & ll ? hx of allergies? ask son? possible recent conflicts with others? last oral intake ( if possible to know)meds or meals...Any recent changes in HTN meds? Pupils are? GSC? arriving on scene--#1 never ASSume a scene is safe. RTA while obtaining SAMPLE. With what I have to go on now- C-spine, package, (Load and go) Naturally depends on if she just passed out or possibly fell into or on something. On truck- suction airway and apply OPA w/ NRB of tolerated/if not then NPA w/^ O2 @ lpm depending on spo2 and possible CO2 level if obtainable. NS & LR IV "18g" @ tko....More info to decide transport method....Begin ALS assessment. neuro exam, assist medic with 12 ld. etc Give more info please!!! We should do more of these
cosgrojo Posted July 10, 2007 Posted July 10, 2007 ERdoc- Does this patient have tachy brady syndrome? Because it sounds just like a call I did recently. If so.. she needs a pacemaker!
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