You look so good in mauve....

[hammerpcp]

Called highest priority to a residence....call made by a third party caller- apparently a dr's office- for a possible seizure.

So you arrive scene and follow a guy into a bedroom at the back of the residence where the pt supposedly is. you left everything in the truck because you're cool like that.

You come around the final corner to see........A big fat guy.....i mean BIG..I'd put him at just under five hundred......approx 50 y/o male, in bed naked (why god why?), is is sporting a lovely shade of purple/blue from head to toe, is breathing spontaneously at approx 26 bpm shallow, he has on a nasal cannula, he is not rousable to loud verbal or painful stimulus.....his brother tells you (after you've sent one of the fire guys to track him down) that this pt has CPOD and thats all he knows about hx.

You're on!

[spenac]

Quick use your camera phone and take pics and send them to everybody with text message to get your butts over here to help lift.

Whats his breathing sound like?

Any grape soda cans around the bed?

Send partner for jump bag and monitor because you stupidly forgot to check that your partner had done their job.

[AnthonyM83]

Because you stupidly forgot your jump bag, you get to do mouth to mouth, now. Lucky you! JK

[dahlio]

Any chance the O2 via NC caused hypoxia since he has COPD?

[JPINFV]

Well, while your partner is out getting the gear, let's start with what we can do. Ask the brother if this has happened before and what his baseline mental status is. Also turn the NC up to 6 LPM and see what a head tilt chin lift does for his breathing.

[hammerpcp]

Hmmm....interesting suggestions. First I am against cell phones, [rant/on] more specifically I am against astronomical bills and mega corporations that think they can treat their customers however they want [rant/off] , so i don't have one....also there is that sticky little pt confidentiality issue. But you're in luck, four well rested and fed fire boys are right behind you as well as your ever-prepared partner with the cardiac monitor/defib and O2 bag.

Brother is MIA. He seems to have gone out for a pack of smokes. He does tell you that he found the Pt in this condition approx one-two hours ago. The brother could not rouse pt so he gave him some more time....perhaps to sleep it off? I dunno. When the brother could not wake him still he called the family Dr who called 911.

Head tilt chin lift wont help this dude much on its own. He is purple. What about sitting him up? Perhaps a little beached whale syndrome?

I'm no rocket surgeon but there is no chance that the NC caused hypoxia.

Okay so no mouth to mouth because your partner has saved the day with your equipment bag. BVM it is!

Negative for grape soda cans.......not sure about the relevance of that but what the hey.

so you get your little three leads on the guy...who is soaking wet....and your pulse oximetry......you have a sinus tachycardia about 120 and an SpO2 of 73%.

You also scrounge up some meds: blue puffer, orange puffer, grey puffer type dealy and

some pills for reactive airways (non steroidal), also some lasix. But that's it. The colour coded meds is just a little test for no particular reason. I will name them if you need.

[JPINFV]

Head tilt chin lift wont help this dude much on its own. He is purple. What about sitting him up? Perhaps a little beached whale syndrome?

I'm no rocket surgeon but there is no chance that the NC caused hypoxia.

You want to try sitting up a 500 lb patient alone? Be my guest. As far as the NC, it was a stop gap since you didn't have anything else at the moment.

[Kaisu]

at some point, preferably after your assessment, you know you are going to have to tube him.....

[fiznat]

Well there are a lot of things we'd want to know. As much history as possible, I suppose, but if that is unavailable:

-Full set of vital signs

-Lung sounds

-Blood sugar

-ETCO2 would be nice to really evaluate that breathing/perfusion/etc

-Neuro checks (pupils, reactivity to painful stimuli, babinski, etc)

-Physical exam. Is the purple color cyanosis or something else?

etc etc etc

Things I'd want to do:

-Call for more resources and a supervisor. We've dealt with 500 pounders before at my company, and it took LOTS of help, including a huge tarp, to drag the people out of their homes.

-Basic airway adjunct, NRB O2 or BVM if appropriate.

-Remaining treatment guided by exam

Need more info!

[rock_shoes]

You want to try sitting up a 500 lb patient alone? Be my guest. As far as the NC, it was a stop gap since you didn't have anything else at the moment.

I think you must have missed the part where "hammerpcp" mentioned you have four well fed firemonkeys at your disposal.

Hammer what's the grey inhaler. I recognize the blue(Salbutamol, Ventolin) and orange(steroid inhaler) right away but not the grey.