DwayneEMTP Posted December 26, 2007 Share Posted December 26, 2007 A scenario given to me during clinicals, reported as a real call. There is very little information available, as I was told there was simply no time to collect it. Dispatched to DOB (difficulty of breathing) Dispatch informs you en route that the caller requested EMS due to DOB. Obvious respiratory anxiety on phone, 1-2 word dyspnea. While attempting to collect additional data the phone is dropped, line still open, and dispatch is unable to get the caller to return. U/a you find an approx. 45 y/o male supine on his living room floor. No sign of violence. Immediate impression is that this patient is Circling the Drain. No discernible lung sounds bilat, no wheezing/stridor, obvious extreme air hunger, cyanosis clearly present at lips, unable to speak, eyes panicked but tracking, PERRL, LOC steadily decreasing. Some diaphoresis, though not dramatic. Tachy @ 176. Unknown BP though pulse is strong and full. No history possible, no family/bystanders present. No medical jewelry or other info discovered. No sign of drugs, prescription or other. No indication of ETOH, apt is clean and well kept as is the patient. No ashtrays or other signs of tobacco use. I will give information as I can, as I was given it within the scenario. If the information requested is extensive, I will simply let you know that the patient died during is collection. I'm looking for THE necessary treatment(s)/intervention(s), not every possible treatment/intervention. For the record, I killed this patient about 6 times before I managed to save him... Again, this is a real call (I was told) you have only a few moments to offer the proper treatment(s)/intervention(s) to save the patient. What will you do? Also, if this scenario is obvious to you, as the medic claimed it should have been to me, please don't answer immediately so as to give others a chance to follow their own logic tree to an answer. Have a great day! Dwayne Link to comment Share on other sites More sharing options...
akroeze Posted December 26, 2007 Share Posted December 26, 2007 How old is this patient? Is there any past medical history immediately available? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 26, 2007 Author Share Posted December 26, 2007 Hell...Part of my post got eaten again...I will edit it to add it back into the original post. Sorry about that akroeze. Dwayne Link to comment Share on other sites More sharing options...
Lone Star Posted December 26, 2007 Share Posted December 26, 2007 A scenario given to me during clinicals, reported as a real call. There is very little information available, as I was told there was simply no time to collect it. Dispatched to DOB (difficulty of breathing) Dispatch informs you en route that the caller requested EMS due to DOB. Obvious respiratory anxiety on phone, 1-2 word dyspnea. While attempting to collect additional data the phone is dropped, line still open, and dispatch is unable to get the caller to return. U/a you find an approx. 45 y/o male supine on his living room floor. No sign of violence. Immediate impression is that this patient is Circling the Drain. No discernible lung sounds bilat, no wheezing/stridor, obvious extreme air hunger, cyanosis clearly present at lips, unable to speak, eyes panicked but tracking, PERRL, LOC steadily decreasing. Some diaphoresis, though not dramatic. Tachy @ 176. Unknown BP though pulse is strong and full. No history possible, no family/bystanders present. No medical jewelry or other info discovered. No sign of drugs, prescription or other. No indication of ETOH, apt is clean and well kept as is the patient. No ashtrays or other signs of tobacco use. I will give information as I can, as I was given it within the scenario. If the information requested is extensive, I will simply let you know that the patient died during is collection. I'm looking for THE necessary treatment(s)/intervention(s), not every possible treatment/intervention. For the record, I killed this patient about 6 times before I managed to save him... Again, this is a real call (I was told) you have only a few moments to offer the proper treatment(s)/intervention(s) to save the patient. What will you do? Also, if this scenario is obvious to you, as the medic claimed it should have been to me, please don't answer immediately so as to give others a chance to follow their own logic tree to an answer. Have a great day! Dwayne Place the patient in high fowlers position on the cot SPO2 assessed prior to administration of O2 (15 lpm via NRB) Reassess SPO2 levels Prepare for syncopal episode, have OPA and bvm ready to assist with ventillations. While getting the general impression of the house and pt, (obviously a full 'nose to toes' IPS isn't the main concern here) do we note any signs of trauma? I know you said that there was no signs of violence, but we also know that signs of trauma and signs of violence arent always the same thing..... Transport pt priority 1 to closest appropriate facility with ALS intercept enroute. Link to comment Share on other sites More sharing options...
vs-eh? Posted December 26, 2007 Share Posted December 26, 2007 Tell the patient that next time he should chew his food. 1. Manual maneuvers 2. Laryngoscopy with the McGill forceps 3. Surgical airway (depending on where the FB is) or advancement down into a mainstem (likely right) bronchus. Ask for pat on back for saving life and a little lovin' from hot Asian-American daughter... Dare to dream... Link to comment Share on other sites More sharing options...
ERDoc Posted December 26, 2007 Share Posted December 26, 2007 Tell the patient that next time he should chew his food. 1. Manual maneuvers 2. Laryngoscopy with the McGill forceps 3. Surgical airway (depending on where the FB is) or advancement down into a mainstem (likely right) bronchus. Ask for pat on back for saving life and a little lovin' from hot Asian-American daughter... Dare to dream... I was thinking the same thing. If that doesn't work the guy buys himself an immediate tube. Link to comment Share on other sites More sharing options...
p3medic Posted December 26, 2007 Share Posted December 26, 2007 Yeah, and if its not obstructed it sounds like he's buying the tube anyway...perhaps tight astmatic... Link to comment Share on other sites More sharing options...
Kaisu Posted December 26, 2007 Share Posted December 26, 2007 dypsnea progressed to complete lack of air movement... the man gets a tube.............. I worry if its anaphylaxis or asthma, copd or heart AFTER he's being ventilated.... Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 26, 2007 Author Share Posted December 26, 2007 OK, I no longer feel like such a dork, I didn't think this was a slam dunk. I'm going to put (more or less) the above ideas together. Manual maneuvers (vs-eh?) = Abd thrusts I'd imagine? You apply abd thrusts to dislodge any physical blockage. After the first thrust, the patient becomes unresponsive. No food is dislodged, and visual inspection doesn't reveal an obstruction. An OPA is inserted, bagging is attempted, but there is little to no compliance to bagging. You decide to intubate. You easily visualize the tube passing the cords, the tube passes with no indication it's encountered an obstruction. Bag is attached, but there is very little compliance to bagging. Oh...LS...No sign of trauma or injury. Patient is completely unresponsive, extremely cyanotic, Nearest hospital is 15 mins away, you have all the help you want, what are you going to do? This patient is still salvageable!! Dwayne Link to comment Share on other sites More sharing options...
AnthonyM83 Posted December 26, 2007 Share Posted December 26, 2007 Blood sugar and skin signs / temperature ? Link to comment Share on other sites More sharing options...
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