ibemt31

Hey All. Had an interesting case earlier today and was wondering what you all think or if anyone has had anything similar. We were dispatched for a sick party. We find pd on scene with a gentleman, in his 40s, lying on the ground, but CAOX3, albeit slightly lethargic and grossly diaphoretic and flushed. The pt complains of no pain and simply states he is tired. Pt denies any pervious HX/RX. Pt NKA. Pupils are pinpoint, and up until this point this sounds like typical opiate use. However, once we got him in the bus and got a set of vitals, pt`s vitals did not seem appropriate for someone under the influence of opiates. His vitals were initially HR 140 RR 26 and BP 210/110. vitals and mental status remained consistent throughout the remainder of the call, and nothing else of note occurred. Just wondering what you all think he was on/what the issue was. The pt admitted to etoh consumption and denied an other drug use(which by the way broke my bullshitometer, no i have to go get it fixed......) Speedball maybe? Curious as to what you all think.......

Whether the Doc administered anything prior to my arrival, unfortunately, is unknown, happiness. The pt did not have an IV when I arrived. The jail medical staff were far too frantic to provide any useful information such as this, and I too busy to ask.

I was browsing the forums and suddenly thought of an article presenting an ethical dilemma that I read in a magazine once, I think it was in JEMS. I don`t remember every little detail, but it went something like this. You are dispatched to an unconscious 3 y/o male. Upon arrival you find a frantic father, flipping out, begging you to help his son. The father informs you that the child suffers from a terminal illness. The child is unconscious and is in respiratory arrest.You begin to work the child up, prepare him for transport, and place him in the ambulance. As you place him in your ambulance, he codes. The father, even more frantic now is near tears as you initiate CPR. After a round of CPR, you are interrupted by a knock on the back door of your ambulance. It opens and you are greeted by the pt`s mother, who orders you to stop CPR immediately, as her child has suffered enough, holding in your face a valid DNR signed by both parents. Both parents are the pt`s natural parents and both have legal custody of the child. What would you do? IBEMT31

Hey all, I had an interesting run that I would like to share with the EMTcity community, to see what they think may have ultimately lead to my pt`s death. We were dispatched to a correctional facility with the initial dispatch of a BLS sick call. Upon our arrival, however, we found our patient to be semi conscious and incapable of coherent speech. the frazzled doctor and nurse, who commanded me to get the pt to the hospital "NOW!!", disregarding the escort required by protocol, and informed me that our pt, who had a hx of gastric ulcers, had developed severe abd pain, before "deteriorating". i was told that his Spo2 was initially in the 50s but had come up to 81% with an NC. ( Why no hi flow? good question...) i was also informed that the pt had become bradycardic, his current radial pulse being 40 and weak. i immediately went with some hi flow o2, based on the sats, and some severe visible distress, until i could determine what was going on. i recognized the need for rapid transport. pt was placed on my gurney and taken as fast as possible (with the escort, whom i hurried along) to my bus. it was during the movement to the ambulance that i realized that the pts respirations were at a rate of about 6-8 and were incredibly shallow, and i knew he would need assisted ventilations. as soon as i placed him in my nearby ambulance, i began ventilating and placed an oropharyngeal airway as transport was initiated. ALS intercept requested but the only available unit was too far away, so we did not utilize them. i continued to ventilate, noticing some involuntary movement upon insertion of the airway, and an increased amount of involuntary movement the more i ventilated the pt. during transport the pulse rate was barely palpable. i was relying mostly on the fact that there was some involuntary movement and some respiratory effort, albeit poor, to assure myself my pt still had a pulse. spo2 during transport was 42% with the pulse oximeter providing a pulse rate of 30. upon arrival at the ER, pt care was transferred. IV access established, pt RSI`ed etc. at one point during my chart writing i checked on the pt to find HR 70s, presumably after some atropine, bp 150/90, pt being bagged. a later check found the pt being worked in full arrest, from which he later recovered with v/s of palpable pulse of 200, and a b/p of 120/90. this was when i went back in service and left the ED. Some minor assessment details: pupils were dilated, and the ED staff found a fresh track mark on pt`s arm. Follow up with the ED today confirmed that the Pt did not pull through, although the doctor i asked about this pt had no further information other than that he did not make it. I am just curious as to what others think. I was thinking AAA, but the BP of 150/90 in the ED does not correspond. The track mark could obviously be indicative of an Overdose, but i wonder if that is the only piece of the puzzle here. To those who usually criticize my grammar, i hope this post is a little easier on your eyes. thanks IBEMT31

OHMEDIC i agree with you wholeheartedly about the BGL. NJ OEMS can be retarded about alot of little things like that. When i said 7 min, that was tx time to the hospital. the time from the 1st b/p to the third b/p was probably a slightly longer interval, perhaps 15 20 min. still an odd finding, which is why i came on here seeking feedback, but then instead of providing that feedback, everyone jumped down my throat for an intervention i provided to a pt that they did not assess treat or even see........go figure

As far as the oxygen, am i sure he DOESN` T NEED it? because unless i am sure of that, i will give it to him. I have very little capability to make that determination in the field as a BLS provider, so the only logical thing to do is to err on the side of caution. Why be so selective with oxygen? except for a few rare exceptions, it is generally harmless, and may in fact be helpful. my philosophy has always been be generous with it. ive seen a marked improvement in many pts who most likely did not have any physiologic need for oxygen as far as pain and comfort, simply by administering some o2. it helps psychologically, and like i said is generally harmless. it is not like say, morphine. i am not saying be generous with morphine, what can happen, but o2....why not?

Im not sure where you work, but where i am is an urban area where we are a hop skip and jump from a hospital. the pt for now is stable, as many people have already said here. perhaps i could have met an als unit in 5 minutes or just gotten to a fully capable appropriate hospital in 7 min......i opted to go to the hospital.

well for one thing, elevated bp=more strain on heart, heart working harder= greater demand for oxygen, why not supplement that and help a little. not to mention the mantra that is driven into everyone in basic class, never withold o2 from someone who may need it.

Exactly, rat, atypical presentation of cardiac issues in diabetics, and htn, apparently new onset as pt was shocked that his b/p was that high is why i went with the nrb, whoever was asking about that. as for a BGL, ask the wonderful state of New Jersey why i cannot take one....my apologies for the grammar guys, 4am does not produce my best writing. as for the stair chair, inside the dark and noisy bar it was hard to ascertain exactly what was going on, and i`d rather stairchair someone who maybe could have walked than walk someone who probably shouldnt have. the edema in his leg was probably due to poor self care of his diabetes, perhaps he fell earlier as etoh abuse seems to be a chronic problem. no areas were hot to the touch, no bruising and as far as complaints, see what i wrote previously, its all in there. no illicit drug use, and the death in the family was recent which did not help issues but i think it only made matters worse if anything, it was not a primary cause of the event. Oh, and no, his b/p was not taken through his clothing.......comon, thats insulting......

I am presenting you with a call which i had, on which the pt, who was intoxicated, appeared to be more than intoxicated, and i was wondering what everyone one here thinks was going on. we are dispatched to a local strip club for a "man down". the bartender meets us outside and tells us he has a man that has came in for a few drinks, but that the man did not seem right coming in, was limping, and just did not seem ok, which is why he called. inside we find a dark and noisy strip joint, not a good place for a thorough assessment. the man is standing, AAOx3, and had no real complaint, stating that he was fine. I decided to continue my assessment in the bus. place the pt in stair chair, remove to ambulance. upon further questioning and assessment, the pt is c/o pain to r. leg, and some minor edema to l. ankle area. pt states he has been in the bar having some drinks. pt is warm dry and pink, lungs clear bilaterally,no visible trauma. pupils PERL. Pt now states HX of diabetes, and quadruple bypass(less than one year ago). pt states he is on a bunch of meds which are home and does not know what meds. pt appears agitated throughout but for the most part is cooperative. upon assessment of V/S RR18 non labored, pulse 100 strong and regular, and B/p of 200/118. due to HTN and cardiac HX, i decided to admin some Oxygen, via NRB. enroute to the hospital, after some 02 pt v/s reassessed, rr 18, pulse 96, bp 150/100. pt care transferred to ed staff. he was placed on a monitor, and v/s in the ED were rr 20 pulse of 120 and b/p of 90/70. at no point did the pt c/o any chest pain or sob or anything else that wasnt mentioned. however, pt did get upset when he found a picture of a deceased relative in his wallet as we were arriving at ED, i do not think this has a bearing on anything, just providing the most complete picture of the call i can. the change in b/p is very interesting. now that think of it, an additional piece of information. my b/ps were all taken on the left arm while the hospital`s b/p was on the right arm (dissection? i doubt it but who knows?) just a peculiar case that i would like to see what other people can hypothesize on. thank you.

Mediccjh, I hope this grammar is easier on your eyes than the grammar in my previous post. My previous post was written while I was half asleep. I do appreciate pointing our my lack of proper grammar, however it was due to inattention and exhaustion and not ignorance. 8) I applaud you, you figured my username out. lol I am not trying to hide that I am indeed from Ironbound. I appreciate the input that you have provided. I am seeking feedback, which is why I posted this case on here. I am here to learn, to become better at what I do. The patient in question was a female in her forties. I would not classify her as athletic, but she was small in stature. She was on singulair for asthma, and a medication that I cannot recall that was prescribed due to gastrointestinal problems related to Gallbladder removal. The pain seemed to originate at the level of the zyphoid process in a "band" of sorts, across the thorax. This pain radiated directly superiorly, moving pretty much across the entire chest, not necessarily to one side or the other. As you advised, this patient was placed on o2 and transported nice and easy with ALS to the hospital. Perhaps it was a small Pneumo, as you have suggested. Perhaps it was something else. Thank you for your input, like I said, I am here to learn, for that is one thing we never should stop doing.

ummm if you read my post properly, i dont recall mentioning anything about bgl specific to this call, i was stating that it is in general retarded. please read post carefully before commenting in the future. i am being attacked because i answer everything everyone asks about the scenario and then someone else chimes in and asks how it applies to the call, i dont know how it does ask the person who asked what her bgl was.

after considering what you all have said, i realize PE could be a real possibility, now that i think about it. also, whoever was implying that this pt was potentially serious, just know she was treated as such. high flow o2, rapid transport and request for als personnel. just wanted to see what everyone else thought. it is not our job to diagnose, but to treat for potentials and treat what we see. and btw it IS retarded for NJ bls not to be able to check BGL. if i suspect hypoglycemia i can administer oral glucose but i cant verify hypoglycemia with a procedure so simple that patients and their families are trained to do it. that is retarded.

spoz 100% on high flow 02. no joint pain no anxiety hx, but hx of claustrophobia, if you read earlier post

no seizure activity noted pt aaox4, no nausea/vomiting, slight dizziness noted. bls in NJ is not allowed to obtain a BGL (retarded, i know tell me about it) pain radiation as i mentioned was up into the chest from pain orginating at about the level of the zyphoid process. do not recall a family hx. rx- singulair for asthma, an unknown med for her gallbladder removal, NKDA. last oral intake was inflight meal, pt denies eating fatty foods. negative diaphoresis, no other hx other than what i mentioned. no recent illness, gallblader surgery 1 year ago. Lung sounds clear bilaterally, and i do not know what she was like during the episodes, i wasnt on the flight :wink: she stated she couldnt take a deep breath during the episodes, and it sounded like she probably was in some moderate to sever distress during the episodes, but like i said i wasnt there. i would disagree with your differentials, no pneumo, she was moving good air with clear LS. and although you never know and i cant rule it out, she didnt seem to be in enough distress to have thrown an emboli. no SCUBA diving or anything like that to my knowledge