brock8024

Ok so you and your partner are woke up at a nice 0400 for a 40 year old black female with chest pain. What you want to know?

aorry i had a call when i was making my last post. he lived. we saved him

REYE's is what was wrong with the kid. I tried my best not to give it away to easy and make it as close to how it woudl happen as possible. I went to by some pepto one night and had to show my id that I was over 18. I read the bottle and found out it could cause reye syndrom. I thought it was interesting since I have taken this stuff as a kid. LOL Like others have said yes it does not have asa in it but contains the

sorry everyone been working alot. Ok so as you are about to leave in the ambulance the mother comes running out to the truck and and says "I do not know if this is important but this bottle of pepto bismo is almost empty. He must have taken it today for his tummy. We have been giving it to him for his tummy."

This might be a long shot but is there a family hx of gallbladder probs? Also where is the abdominal pain? LLQ RUQ LLQ is possible Appendicitis RUQ Gallstones? Get an IV NS

no hx of gallbladder. Pain in all quadrants.

At the ER.... LP?

Neg

Negative for all illegal drugs

I'm not all done, I want to go back to some more basics here,

Why did he seizure, that is the question - > Was it hypoxic? We have not yet grasped his Sats, does he look cyanosed? Did the temp cause it?

What is causing this lack of perfusion -> low BP or is it some kind of anemia, chuck him on Capnography, BSL, skin tenting? Hx of seizures?

Obviously you cant answer all these, so in an easyier format,

Sats

BSL

Capnography

Clothes off, cool the pt

Raise those legs for some cerebral perfusion

Lets try get to the bottom of what the cause of the problem (seizure) is!

88% before intubating 98% after

38mmhg

FSBS as before

What do you think caused the seizure????

What labs do you want

well as far as transport you pt has one other seizure enroute. What labs do you want.

Alrighty then. So we are thinking either infection/sepsis/SIRS, or a toxidrome of some sort. Are there any medications in the house? It isn't your run of the mill anticholinergic or cholinergic OD in any case.

Tube size for a 12 y/o 60lb child. Probably a 6.0. 60lbs is a pretty small guy.

Tube passes easy, everything is good. Parents just have normal OTC meds in their bathroom.

Continue fluid bolus, 5mg valium IV, cont to assist vents with BVM and prepare to intubate.

Find out more about 'strange' behaviour. Was he confused/irritable/irrational? What OTC meds has he been taking? Did he have pain in his abdomen at any point? Has there been any blood in his stools? Is he still vomiting even with the decreased food/fluid intake? What about urination? Any neuro deficits in extremities? Nucal rigidity?

He was just acting irritable. His mom states that he was taking tylenol/motrin for his fever. They do not think he took anything else.He told his mom that he tummy was hurting more than normal the night before. His last vomiting was last pm. Decreased urine and no nucal rigidity.

What size ETT are you going to use.

As you go to load him up he starts to have a seizure. His mom is now yelling at you to help her son and stop playing around.

Mom states that he has had NVD for the last few days and stayed home alone today. Does not think he has eaten anything.

Any family history?

None his mom and dad figured everyone woudl be comeing down sick with the flu.

Oh and how does his condition change after O2. I'm to decide what to do with airway/breathing.

Would 12-lead (enroute) be too much? I'm just thinking that b/c obviously not perfusing well.

I'd start loading now.

He is still not perfusing well. 12 lead shows sinus tach

He has an infection! Lung sounds? cough? sputum? diarrhea?

Aspiration pneumonia for 100 Alex. What is meningitis? maybe SARS. Probably septic. Peritonitis?

Oh! Rabies!

Does he have any hx?

Start some NS anyway. Does he need ventilatory support?

He has not been bitten by any animals. Umm mother states that he was acting funny last night. He is normally nice and calm but last night before bed he seemed moody and did not want to be touched. he is breathing has increased to 36-40 and labored.

Avian flu. I'm outtie!

How is abdomen on palpation? What did his 'stomach' flu consist of? Cough? Pain anywhere? Soreness? Photosensitivity? Sore Throat? Fever (or is this new onset)? Diarrhea? Vomiting? Eating/Drinking? Any semi-recent injuries?

He has some withdrawal from pain on his abd. His bowel sounds are hyperactive. He has had NVD. He has had the fever for a few days and has been taking OTC meds for that. he has been eating less and less.

Interview Parents:

What more can I get out of them? What was he doing prior to to this? What made them get up at 4AM? Was he crying out? What did he do yesterday and days before? Trips or outings? Has this happened before? Normal mental status and ability?

Get a SAMPLE.

Partner

Can your partner do a scene survey of the room, kitchen, garage, and anywhere else they might find toxic cleaning substances, etc? Any smells in the room? Are medications all accounted for?

Assessment

Now that you're at his side, How is his airway, breathing (rate, quality, lung sounds, visual), circulation (pulse rate, quality, cap refill, PMSC of extremeties), GCS, pupils, BP. Do we have monitor, O2 sat, finger stick, thermometer. Physical exam, signs of trauma or anything else, signs of "SLUDGE"?

Will he follow commands enough to tell you what's wrong or point where it hurts or get more of a neuro eval?

Tx:

At this point, [high] O2 and get IV ready, I suppose.

Parents state that he has been sick for a few days. His mom got up to check on him and he just would not wake up as well as normal. His mother states that he has not had anyother problems normally. Mother states that other than having a stomach flu the past few days he has been great. Last night before bed he was acting really tired.

his breathing is labored with some stomach muscles being used. Lungs are clear bilat. Pulse is rapid and weak. cap refill greater than 4 secs. GCS is 9. E=2,V=3,M=4. Pupils Pearl and slightly slugish. BP- 90/40, HR - 148 Sinus tach, FSBS 82 mg/dL. RR 28 labored. Temp is 103.2 F. No signs of trauma. neuro is GSC as above.

S- NVD

A- NKDA

M- No RX meds

P- None

L- soup last nice

E- nothing makes beter.

No meds missing. Parents states that they let him alone today while they was at work. No toxic stuff missing.

What do I find? Sex, approx age, size, weight, position, breathing, skin signs, level of consciousness, what does it seem he is doing or was doing last, anything else that stands out as I walk in?

You find a 12 year old male pt that is approx 60lb. pt is supine in bed. Pt's breathing is labored, skin is hot dry, flushed. Pt does not talk to you only cries out for his mother. As far as the heaters they had them cleaned and started and their CO detector has not went off.

It is a cold november morning when you are awaken at 0400 hours and dispatched to a 12 year old male that is not acting right. Upon your arrival you find a mother that is frantic and is yelling at you to help her child. The father directs you to his bedroom where you find your patient.

Take it from here.

Well I for sure never choose either way when I was younger. I do remember when it hit me that I was different. I will have to do some research on this subject, but even if I do find stuff there will be someone who says that the data is messed up. Seems how it always goes if you are against something you find faults in the studies.

As far as sex goes how many hetrosexuals truely have sex just for that reason. None other. I would say not many. It is something that feels good and bonds you to the one you love. We are a smarter breed of animal than that. I mean gays did not form gay parents. LOL

I have never advocated harming someone because they are homosexual. The problem I have with the "organized homosexual movement" is in the whiny, perpetually offended give me my rights or else approach they assume. Even to the extreme of exposing children to disgusting behavior in public. One even said a few days ago that "gay is the new black" I suppose he is trying to attach their chosen lifestyle to the roughly 221 years of african slavery on this continent. (And no I don't think they deserve one dime in reparations) Anyway this is an example of just how desperate these folks are to validate their lifestyle. I submit that it is disrespectful to equate a lifestyle CHOICE to the legacy of those that suffered the horrors of slavery as well as during the civil rights movement. Please dont try to associate yourself with the incredibly honorable folks that scaramedic listed.

Now with all of this said please understand I have very good friends that are homosexual and we often have spirited debate about these subjects, but at the end of the day we are still friends respectful of each other as a person. I offer you that same respect sir.

I have a few problems with this.

First you said "Even to the extreme of exposing children to disgusting behavior in public."

So what you are saying is that when heterosexuals are kissing and groping and wearing sexual clothes in public this is not exposing children to disgusting behavior in public. I am sorry but I have seen many heterosexuals saying and doing some nasty things in front of kids. Where I live the worst I have seen so far is maybe two guys kiss or hold hands in public. And what about all these teenage girls who wear clothes way to reveling for their age. Like I said I do not understand this comment because it is two fold. yes sometimes gays can do extreme things to get attention in public but heterosexuals do the same thing.

"Please don't try to associate yourself with the incredibly honorable folks that scaramedic listed. "

So what you are saying is that their lives are more important than the gays that are torchored and beat to death? That is the way it sounded to me. I may be wrong and if I am please explain.

again please excuse my spelling.

Scaramedic you are very right there are many killed in this world for who they are. The people you listed are from other countries. The ones I listed where all from the USA. I am not saying that their deaths are any less important.

I guess we can all say we are discriminated against to some point. The thing I do not understand is why we have to beat or kill each other. I am not going to go out and beat or kill a person just because they believe different or because they are straight and justify it.

The one thing we can not agure about is that we live in a great country here in the USA. We get the right to think how we want to. We have a great constitution that regulates us and our government. We are able to question our government without the fear of being killed. I can understand why so many try to come here illegally.

As far as the gay thing as the new black thing. I do not see that. we are all people. whether you think we are born gay or chose so be it. I just do not understand how people can kill another human just because they do not believe the same or live the same.

I try to go to church as often as possible. what I have leaned about our GOD is that he is a very powerful and forgiving god. No where in the bible have I ever read where it said go out and kill the gays or blacks. I guess I do not understand how the people who kill gays or blacks or abortion doctors sleep at night and proclaim to be christians.

I am not trying to start a religious battle either. I know what the bible says and I have my belief system in place. It just makes me mad that what most people see on tv is the flamming queens that make a bad name for all of us that want to live our life like ever one else and work and then die with our loved ones by our side.

sorry for my spelling

There has been some great post. It is always funny to me when people get mad or think we do not need our parades. It is a way for our community to come together one time a year and have fun. I have only marched once and it was a awesome thing for me anyways. I mean we came to the top of a hill and looked down to see thousands of people cheering, it was amazing and i actually almost cried.

Now do I always agree with the people in them nope. Actually I get embarrassed alot of the times. I mean drag queens and things are part of my culture. i by no means take part in it but hey they can do as the please.

Like someone said women and other groups did not get their rights without some type of marchs and protest. I think it is funny when you have all the right wing people saying that gay marriage will never work but you have all these straight people getting divorces after a few months or heck in some cases a few hours.

All I know is that this is a great country. If I do not like what I see on TV then it is just a matter of a click and it is gone. I do not agree with everything I see in this world but at the same time I do not go around bitching about it either.

And as far as the parades go and people marching and things. You have to remember in even todays world, we still fear being beat, and raped or worse for who we are. That is one reason we do it. In the town I live in we had a two guys that came out of walmart and was followed home and beat in their front yard for being gay. So if you ever wonder why we do it just remember some of these headlines

Confession at Gallaudet - gay killings at school - Brief Article

National News Briefs; 2 Brothers Arraigned In Gay Killing

Lakeview Angered Over Gay Murders

An old case poses questions about past Detroit police investigations of gay killings

NYC Gay Bashing Victim Dies After Family Removes Life Support

Gay cowboy bashed and left for dead

Matthew Wayne Shepard

I could post alot more but this is why we have to protest and march. To make sure that the people who are killed get justice and to protect the ones that have yet to be killed.

In my area it is all vol. fire guys. We have great first responders in our areas. I work for a county service right now and we cover about 5 or so small towns. I mean no stop lights in some of them. Most of the repsonders are emts that no longer work for a service. We have a few younger guys. I will say that they are aweomse. I have not been on scene yet where I had one not help or anything. As long as I ask and say thanks and do not act like they do not know what they are doing. In another words treat them like a human then they are fine.