Unconscious

[Sdowler]

Ok lets see,

Pt is rapid transport

request ALS

C-spine protection

any other patients?

A) gurgling respirations - reposition airway with jaw thrust since we can't rule out trauma suction prn

8/min tolerates NPA gag reflex if the patient is pink and people are limited my questions are: will the NPA allow us to use a nrb or does my partner who is maintaining spinal precautions having to jaw thrust her still. If shallow resps BVM @ 10/ min

Question lung sounds

C) skin color temp and moisture Iv lock as noted above base line V/S

Monitor 12 lead BGL is fine

Seems no finding for RTA

Seems Initial GCS of 10

Secondary survey:

Review ABC changes and monitor therapies head to toe palpation inspection auscultation, meds allergies

any odors in the house any other feeling ill?

[Sdowler]

what is her h&h

trendelenberg :twisted: :twisted: :twisted:

[Dustdevil]

I want to find her meds. Are we seeing empty pill bottles anywhere? Bedside, trash cans, bathroom? Big pitcher of water that is out of place? I'd like to see that EKG.

Are her lungs good? What about her temp? Sp0[sub:8bb4c19623]2[/sub:8bb4c19623]? With our assumption of a safe scene, then I guess CO poisoning is out of the realm of possibilities.

Without signs of trauma, and assuming her oxygenation is okay, I am happy with an NPA for airway at this point. And assuming the EKG and lung sounds are unremarkable, I'm going with a fluid challenge on the way to the hospital.

[Sdowler]

Dust what is your opinion, nasal intubation or RSI if the NPA is not good enough and the pt is difficult to ventilate.

Side note what is her EtCO2?

[AZCEP]

What is her "normal" blood glucose level? 132 mg/dL could very well be hypoglycemic for this patient.

ECG? Pupillary response?

She seems to be protecting her airway adequately for now. Move to the transport unit.

[Just Plain Ruff]

I'm with dust, what medication bottles can you find and what are the numbers of pills in each bottle? This could be a combination reaction the a pharmacopea of medications.

Did we check pupils?

Does she feel hot?

But Seriously doc, this isn't pufferfish poisoning again is it?

Waht are her vitals

pulse,

bp

rr

we know the sugar

12 lead or cardiac monitor

What time of year is this scenario goin on at? How long has the son been in the house and is he exhibiting any symptoms of CO? How bout the EMS Crew?

If she's unconscious with unknown etiology I'd suspect

1. Diabetes

2. cardiac

3. CVA

4. infection

5. environmental(CO?)

[EMSGeek]

You said gurgling respirations...is the airway clear, any fluid, if so what?

Definitely interested in the meds (look at quantity of pills and compare to date issued as well as rate to be taken, try to determine if OD is a possibility). Make sure the pt is in the sniffing position. Any difference in pain response between left and right sides?

Last time she was "normal" was when the son last saw her? How long ago? May not be much but it's something.

Any ETOH around? Smell anything on her?

[CBEMT]

Seems Initial GCS of 10

Huh??

You give her a sternal rub and she just moans a little.

Sounds like a 4 to me... :roll:

[Just Plain Ruff]

Come on ERDoc your slipping. We need more info. please???????????????????????????????????????????????????///

[ERDoc]

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.....

GCS=1,2,1 Pt is minimally responsive to painful stimuli as previously described. SpO2 is 97% with the NPA and O2. You cannot check ETCO2. The son tells you she is on Glucophage, Atenolol, Elavil, Norvasc, Lipitor and Aspirin. No recent illness or injury. The son last talked to her at lunchtime when he called home.