chbare Posted June 14, 2008 Share Posted June 14, 2008 Initiate rapid transport to the hospital. Did he tolerate a NPA or OPA? If so, we may need to aggressively manage the airway. Enroute, we need to obtain a 12 lead and initiate IV access. Provided his lungs are clear without any indication of failure or pulmonary edema, a fluid bolus would be indicated. Do we have a temp as well? What did his neuro and eye exam tell us? Just to clarify, his respiratory rate is 4 per minute and labored and he has stable vital signs? Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted June 14, 2008 Share Posted June 14, 2008 Air entry sounds? Abd distended? How about some vitals now that we are in the unit. BP, Pulse, SPO2, Temp, redo GCS, at my level I would like to use a non-visualized airway (king preferably) and throw the ETCO2 on it. What is the skin condition? Link to comment Share on other sites More sharing options...
unknown Posted June 14, 2008 Share Posted June 14, 2008 Initiate rapid transport to the hospital. Did he tolerate a NPA or OPA? If so, we may need to aggressively manage the airway. Enroute, we need to obtain a 12 lead and initiate IV access. Provided his lungs are clear without any indication of failure or pulmonary edema, a fluid bolus would be indicated. Do we have a temp as well? What did his neuro and eye exam tell us? Just to clarify, his respiratory rate is 4 per minute and labored and he has stable vital signs? Take care, chbare. Chbare is on top of this and its interesting, I just want to follow this thread and see the end results..... Chop Chop ~ Carry on!! Link to comment Share on other sites More sharing options...
ERDoc Posted June 14, 2008 Share Posted June 14, 2008 Perforation???? So, we have an unresponsive 26y/o with a few interesting interesting findings. I agree with aggressive airway management. I would get a finger stick and if he's not hypoglycemic (which we have established at this point) tube him right away. This guy may have suffered some unknown trauma, so let's not give him a chance to do something bad. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 14, 2008 Share Posted June 14, 2008 If he was on a ladder, did he come in contact with any electrical lines? I agree with all the above statements. Any burns to the extremities from electrical contact? How far may he had been on the ladder, distance of fall? What was he doing on the ladder in the first place? Link to comment Share on other sites More sharing options...
Adam Swartz Posted June 14, 2008 Author Share Posted June 14, 2008 Perfusion not Perferation. My tired ass did that. Vitals are BP 125/90 P92 regular R 6 shallow and labored. He does not have any medical alert bracelets. You are able to get a combitube in. SPO2 before the combitube is 84% After is 98%. He didn't fall off the ladder but nice try. No other trauma evidence. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 14, 2008 Share Posted June 14, 2008 Unknown unresponsiveness and no visible trauma, amp D50 followed by 2.0mg. Narcan. That was just our protocols at the time. Remove clothing, especially his shirt to check for small caliber GSW. Heart sounds, clear or muffled? Any JVD? Any posturing? I know, I'm reaching. Link to comment Share on other sites More sharing options...
Adam Swartz Posted June 14, 2008 Author Share Posted June 14, 2008 Ok I am just a basic but my thing is he has a very high BGL. We transport BGL is 560. Get him to the hospital they get him back. He is in a Diabetic coma. He was going to get on the ladder but passed out before he could. He had a fruity breath. He then had a full recovery and was diagnosed with diabetes and now has a medical alert bracelet. Nice job you guys. Link to comment Share on other sites More sharing options...
ERDoc Posted June 14, 2008 Share Posted June 14, 2008 D50 for a sugar of 560 is not going to do much, though it won't do any harm in his case. Diabetic coma and insulin shock are more laymans terms and don't really tell you what is going on. This kid is in DKA (new onset apparently). I would argue that at the scene you still cannot r/o trauma so you need to treat as such with aggressive airway management. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 14, 2008 Share Posted June 14, 2008 D50 for a sugar of 560 is not going to do much, though it won't do any harm in his case. Diabetic coma and insulin shock are more laymans terms and don't really tell you what is going on. This kid is in DKA (new onset apparently). I would argue that at the scene you still cannot r/o trauma so you need to treat as such with aggressive airway management. If not able to check BGL, which we didn't have an accucheck very often, and the ones we did have weren't very reliable. We'd give the D50 just in case of hypoglycemia, and like you said, Doc, if it is hyperglycemia, it won't hurt. Also the Narcan wont' hurt if there is no drugs present. We just tried to cover all the bases in an unknown unconscious pt. Link to comment Share on other sites More sharing options...
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