defib_wizard Posted November 22, 2008 Share Posted November 22, 2008 There is some localized edema around the mouth. Link to comment Share on other sites More sharing options...
Kiwiology Posted November 22, 2008 Author Share Posted November 22, 2008 Tx - 20ml/kg bolus of NS - 2ml/kg of dextrose x 2 - 0.5mg naloxone x 2 - 0.5mg epi IM BP 100/60 RR improves (!) to 6 but are very shallow and agonal; still cyanotic Breath sounds reveal what sounds like bilateral rhonchi or rales Pulse is still 100 and weak Monitor shows the sinus tach is slowing Brother states his sister is not pregnant, tampon check is a negative and the kid says his sister "got on the zebra to gain headaches". In the trash you find a bottle of bisoprolol. Link to comment Share on other sites More sharing options...
defib_wizard Posted November 22, 2008 Share Posted November 22, 2008 ok, now we got some info. ( thanks kiwi ) I think intubation is needed then a call to med control. Since this looks like a probable beta-blocker od. Im going to ask for IV glucagon and see what he thinks about a second iv and an epinephrine drip. This call already is not pretty and is beginning to get uglier by the minute. Also hanging out with the other kids is not an option its time for a diesel bolus! Link to comment Share on other sites More sharing options...
Eydawn Posted November 22, 2008 Share Posted November 22, 2008 Tell me you're putting the other kids in the ambulance with you and making sure they're properly restrained before you take off with the kid who's sick... tell me you aren't leaving kids on a scene by themselves. You mean haul ass with all the kids, or with the other kids with an LEO, right? I keep hearing that you're not necessarily waiting to make sure someone's with the kids in your tone and it's kind of worrying me... not trying to read too much in, but I'd swear we had a duty to make sure little siblings were safe... part of that chain of scene safety.. me, partner, patient, others around me... Wendy CO EMT-B Link to comment Share on other sites More sharing options...
ambodriver Posted November 22, 2008 Share Posted November 22, 2008 First thing i am concerned about with this patient would be airway...I would intubate asap with plenty of suctioning, utilizing etomidate if we had to. I'm not exactly sure what is going on, with lots of mucous in the mouth cystic fibrosis is sticking in my head (maybe b/c I just saw a news article on it), that could account for the rhonchi--far stretch though since the family would probably know something about this due to prior contact with EMS and hospitals. With a possible beta blocker OD I am going to agree with defib_wizard and consider glucagon IV. With rales BB OD makes sense if it is causing heart failure. Glucagon has inotropic and chronotropic effects, however My first concern would be securing an airway, getting the pt. in better position, maybe increasing volume of O2 to help with recruitment of the alveoli, and maybe using PEEP. Honestly I am not sure how long the glucagon IV would take to start working, as I have never used it in the field in this type of situation. and for Wendy not sure where you work but popo's are always there when we need, they could take care of the kids for us. Then gain I live in a big city and have those resources, not even sure where in the ambo I'd put them all especially when I have someone intubated and have my hands full. Link to comment Share on other sites More sharing options...
Kiwiology Posted November 22, 2008 Author Share Posted November 22, 2008 You are unable to pass the tube even with suctioning all the secretions ouf of the airway due to angioedema. This one is basically where the kid was given Zebeta (bisoprolol) for migrane headaches which have caused a slow anaphylactic reaction. Link to comment Share on other sites More sharing options...
defib_wizard Posted November 22, 2008 Share Posted November 22, 2008 Ok surgical cricothyrotomy time. Link to comment Share on other sites More sharing options...
Kiwiology Posted November 22, 2008 Author Share Posted November 22, 2008 You cric the sister and the brother who is watching passes out and whacks his head on the coffee table; oh I am mean Ventilation through the cric tube yields adequate compliance and chest rise with the following- BP 100/60 (no change) RR up to 10 SPO2 97% (up from 80%) PR 70 Cyanosis is decreasing Monitor shows tachycardia decreasing to rate of 80 GCS is still 3 The cops are rolling to look after the kids. Link to comment Share on other sites More sharing options...
defib_wizard Posted November 22, 2008 Share Posted November 22, 2008 epinephrine IM, Albuterol and atrovent svn ( in-line with bvm ) solu-medrol IV Link to comment Share on other sites More sharing options...
Kiwiology Posted November 22, 2008 Author Share Posted November 22, 2008 Yeah that's basically it; started an epi drip (1mg in 1000cc) and mixed up a couple breathing treatmenets (don't carry any steroids) Link to comment Share on other sites More sharing options...
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