brock8024

is the mothers milk sufficient for the baby, what is the physical fitness of the mother, also is this baby a boy if so is there a chance of a testical hyrnia.

mother is a healthy and this is first baby. Mother is 5'4 and 145lbs. baby is a boy.

Baby is breast fed... What has mom been up to? Alcohol, drug use? OTC or prescribed meds?

She has not been taking anything. She looks at you very hurtful when asked about this.

Any skin tenting? Sulken eyes?

Not yet

What do the loose stools look like?

Normal color for babies but more water in them.

Appetite, drinking enough? Breast fed?

decreased appitite, fluids and is breast fed

Fontanelle assessment? Pulse oximetry may be difficult at this time. Do we have a core temp? Any abdominal masses or abnormal findings?

We need to provide some blow by oxygen and start working on vascular or IO access depending on the situation. Pull out the good old Broselow scale. A full term kiddo should be around 3.5 kilograms

Take care,

chbare.

No masses, temp is 99.0 rectal. Ok so get in a IO.

some loose stools and no fevers that she has noticed.

Color and skin condition, signs of trauma, history of present problem, any past medical history, problems during the pregnancy or during child birth? Lung , heart, and abdominal assessment? Any history of vomiting, loose stools, or fever?

Need to have the resuscitation equipment ready to use and we should abtain a blood sugar.

Skin is mottled in extemities. No trauma. Baby been vomiting started vomiting last night. has not been eatting well since yesterday. Normal child birth. Lung sounds are normal just rapid, heart is tachy, abd is soft and baby shows some signs of pain. FSBS is 76mg/dL

Take care,

chbare.

Size up of the scene and general patient impression?

Assess responsiveness and then move into the primary ABC survey.

Take care,

chbare.

Scene size up is a well kept house. Mother is frantic that her baby will not wake up.

A- baby has a open airway

B- resp. rate is 48-50.

C- 4 second cap refill. rapid pulse.

When you tap babies feet you get no response. Baby will open eyes for a few seconds and that about it.

What else.

How far are we?

Any first responders available for first responce? (I assume we are not within a few mins of this baby)

20 mins and first responders are dispatched.

You are dispatched to a rural community for a 5 day old that is difficult to wake up.

Someone start the fun!!!!

I worked a trauma code and got them back. Pt crashed as we went to tube him in the back of the truck. Got him back and he lived 9 days and was a organ donor. It happends just not often.

I work in a really rural area, We cover a huge county and have to help cover other areas since most are just bls services. I am not bashing them but we are ALS. I have yet had to wrok a code alone but I know the day will come. I think you woudl have to think about it and sit it up in the back before you left so that you coudl do it.

Here is a different view on this and why you would want to assess your patient. How long does it take for a patient to get a bed sore from pressure? I am not just talking about coccyx and ischial wounds but any boney spot like shoulder blades, lower back and hips.

Why is this important? Well find out how long it takes and you will see why a full assessment is needed. If she had to lay on a backboard for a long transport and then lay on a backboard in a busy ER waiting, then she could have more problems then when she started.

Skin break down happens faster in elderly patients due to skin changes and nutrition. Your skin starts to change and get weaker starting if I remember in your 40's. So take a nursing home patient that does not eat well or drink well and does not have much tissue over boney areas you could open a can of worms.

I will back board a lot of my patients if they have not been moved and if they are hurting over the boney part of the neck. I know from my nursing homes that it is a fast trip and the ER doctors are fast about getting them off a board.Most of my patients are off the back board in a matter of less than 5 mins.

I will agree. I do not backboard every fall. I mean if they have been moved, walked, or anyother thing then i may or may not. I have done standing take down before on a guy from the jail.

I think the treatment for this pt would be diesel and a surgeon. Well it might be some drugs and fluids when he decides to code on you.

That is correct Spenac - she voided it as she is his POA - so now that he couldn't tell anyone what to do, she took over. She wanted the other kids to have time to get there so that they could say goodbye... He was dying at an inconvenient time... so regardless of the fact that he had talked about his options and come to a decision.. he got tubed, paralyzed and sedated...

Did you read my post??? if he was suppose to die right then or before he got tubed then he would have. It would not have mattered if he was awake and told you no he did not want to be intubated. If her POA was active it is what she wants. Someone please correct me if I am wrong.

Ok here is my deal, we are not gods, we do not make choices for our patients. If that is what she wanted and she was at peace with that then who cares. He probly did not know what was going on. He was paralyzed and sedated. Most people do not know they are on the vent if sedated correctly. I may not have liked doing it but I would have.

Are you the one that has to deal with the kids hating you because they did not get there in time and you done nothing to make sure they had a chance to say goodbye. Are you the one that will for the rest of your life have to wonder if you made the right choice about it. If that is what made her feel at peace and keep peace in her family then who cares. Like i said i bet he had no idea what was going on if he was that far into a end stage cancer stage.

give him some oral glucose. He seems awake enough to swallow.

No, I was referring to the NH not having their shit together, creating the confusion that lead to this guy's care turning into a cluster fark. They'd had him all this time, never put his bracelet on, and lost it. That's about like losing his meds and never giving them to him. That DNR is "care". They had a duty to provide, and the failed. This just has negligence and neglect written all over it.

Do you agree or disagree with the rest of my post????

Does he have any marks on his body from possible needle injections. I would do a FSBS, check a EKG, then look for signs of drug abuse.

He is aox what? x 1 ,2 ,3 , 4????

Person?

Place?

Event?

Time?

Any decent lawyer could make a money-winner out of this case.

Neglect. You would be hard pressed to find a jury who was not incensed by this story.

Correct me if I am wrong dust, but what you are saying if they DID NOT tube him then the wife could have sued.

I know sometimes it is hard to do the opposite of what you patient wants if family is around. i have been made fun of somewhat for keeping DNR's in my truck. In oklahoma a pt can sign when ever as long as they are competent. I have actually had a pt tell me that she did not want anything done if she died and if I would have had one then I would have let her sign it.

This is the way I keep myself sane most of the time.

WHEN IT IS THEIR TIME TO GO THEN IT IS THEIR TIME TO GO!!!!

No matter what you do they will die if it is their time.

These are two important things to remember when you get ur stuff and your on your own.

1) At the end of your day be comfortable and confidant in the treatment you provided. If something did not go how you wanted make sure you change it so it does not happen again.

2) BE ABLE TO DEFEND YOUR TREATMENT!!! if you are called into the your supervisors office or court be able to defend your treatment plan.

How far was you from the hospital?? Would he have been able to make it with just a oral airway and bagging him. This is what I would have more than likely done. I am lucky that the nursing homes and assisted living homes are all within 4 mins of the hospital. So if this came up I would more than likely had just oral airway and bagged til someone found the DNR or I let the ER doctor settled it.

I know from now on when I have a person with a tooth ache I am checking for this. Even with pts with chest pain I am going to check for this. ALot of people may not mention a tooth ache because they think ti is chest pain when it is not.

Sometimes we think toothache and blow it off as a stupid call or what ever. the thruth behind it is that a simple toothache could be in fact have a very bad outcome.

I have to admit that I googled this. I have had trouble with my teeth in the past and had to have a root canal at 16, so this post really got me to thinking.

It turns out that I found the name is Ludwig's Angina. The pus generated by the infection forms pockets which grow and cause cellulitis in the face and neck. These pocket of pus cause the airway to close off and sufficate the person. Hence, the life threatening emergency.

Now, the next question for others.....How can this type of infection develope to the point that it's life threatening?

That is the name of it . The ER doctor said he has only seen two cases of this. I had no idea this is what was wrong with my pt. She was intubated and sent to the ICU and was discharged.

One of you are really close but there is a name for it. Not saying who is close though. LOL

Sepsis?

Sorry but that is not right. Please explain why sepsis would cause her airway to be obstructed.