fireflymedic Posted July 11, 2008 Share Posted July 11, 2008 You are a rural EMS service called to "steven king's rest home" which houses both the elderly and mentally challenged together for a sick person. Upon arrival, you enter the abadoned looking facility searching for a nurse to get a room number of where you need to go in the four story facility. You cannot find a nurse to get any information, so you start going from room to room when you hear a large thud from the floor above. You go upstairs to investigate (still trying to find a nurse) when you see a door dislodged from it's hinges. Upon opening the door, you find a rather large female (approx 400lbs) on the ground, naked, covered in vomit and urine and cyanotic. She is completely unresponsive and you begin care for this patient - what would you like to know or do? You are the only truck available with over an hour to the closest hospital. Your truck is a basic/medic configuration. Link to comment Share on other sites More sharing options...
letmesleep Posted July 11, 2008 Share Posted July 11, 2008 This NH sounds oh so familiar, how about we start off with a primary assessment up to and including some vs, BP/RR/HR/SAO2/ pupils, skin, d-stick. what does the vomit look like? send my partner to FIND A CARE GIVER of some kind to get some kind of paperwork on this Pt at a minimum, dispatch another ambulance in case this isn't the only Pt no matter how long of a response they might have at this point......I'll start there. Link to comment Share on other sites More sharing options...
itku2er Posted July 11, 2008 Share Posted July 11, 2008 You are a rural EMS service called to "steven king's rest home" which houses both the elderly and mentally challenged together for a sick person. Upon arrival, you enter the abadoned looking facility searching for a nurse to get a room number of where you need to go in the four story facility. You cannot find a nurse to get any information, so you start going from room to room when you hear a large thud from the floor above. You go upstairs to investigate (still trying to find a nurse) when you see a door dislodged from it's hinges. Upon opening the door, you find a rather large female (approx 400lbs) on the ground, naked, covered in vomit and urine and cyanotic. She is completely unresponsive and you begin care for this patient - what would you like to know or do? You are the only truck available with over an hour to the closest hospital. Your truck is a basic/medic configuration. Run like hell and say patient not found....LOL just kidding Open air way check ABC's, Be very aware of what was going on around me while doing this. Radio for FD and lifting assistance. VS pulse ox? Since you cant find a nurse to get a hx You have taken care of ABC's a quick BGL wouldnt hurt anything. opps forgot suction prn IV O2 monitor. Link to comment Share on other sites More sharing options...
spenac Posted July 11, 2008 Share Posted July 11, 2008 Call the funeral home cause I aint getting dirty. :evil: Link to comment Share on other sites More sharing options...
fireflymedic Posted July 11, 2008 Author Share Posted July 11, 2008 This NH sounds oh so familiar, how about we start off with a primary assessment up to and including some vs, BP/RR/HR/SAO2/ pupils, skin, d-stick. what does the vomit look like? send my partner to FIND A CARE GIVER of some kind to get some kind of paperwork on this Pt at a minimum, dispatch another ambulance in case this isn't the only Pt no matter how long of a response they might have at this point......I'll start there. This was a real scenario - complete from my last shift so anybody wanna come work with me? Okay, here's some vitals to let you start playing BP : 180/110 RR : 8 - snoring, inadequate HR : 64 SPO2: 80% on room air Pupils : dilated, very sluggish to react BGL - 72 Vomit : greenish yellow slime with chunks of what once resembled carrots in it AVPU : unresponsive GCS : 5 - (1 eyes, 1 verbal, 3 motor - appropriate flexion to painful stimuli) Monitor : NSR - no ectopy present Your partner finally chases down the cafeteria worker who tells you one nurse just walked out on the job and she doesn't know where the other one is. She tells you best bet is to find an aide. On the way, a janitor informs you that the elevator is broken so you'll have to carry the patient down two flights of stairs. You call for fire who informs you they are busy and you will have to call the jolly volly rescue squad (they inform you they will respond as best they can - show up with 3 people). Your partner finally returns with an aide who says "oh crap, that's her" and runs off. An additional BLS truck is 30 min out with no other ALS available. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 11, 2008 Share Posted July 11, 2008 I'm with itku2er . . . run while you still can . . . Link to comment Share on other sites More sharing options...
Echoburger Posted July 11, 2008 Share Posted July 11, 2008 I was thinking. Yes. Me...thinking...well anywhoo... I would start off by the airway...provided that she has snoring respirations, I am going to assume that the airway is obstructed. I would preform a Jaw-Thrus, if the Jaw-Thrust failed...I would use a Head Tilt Chin-Lift. I would suction and clear the airway...insert an OPA and start bagging the pt. We're gonna try to get the o2 sats up to 96%, at best. Circulation...pt's got a pulse, even though it is close to being bellow 60...so we would be considered about that. Package pt to a LSB, do a rapid trauma assessment...try to get history/meds/allergies from nurse. Consider a Helicopter, and redo vitals every 5 minutes. Thats all I can think of...somebody help me out. lol Link to comment Share on other sites More sharing options...
letmesleep Posted July 12, 2008 Share Posted July 12, 2008 first of all is this confirmation that this is our only pt? "Your partner finally returns with an aide who says "oh crap, that's her" and runs off." If so, cancel the inbound BLS truck! ECHOBURGER has an OPA in and bagging, lets get her suctioned out and get her intubated, we got what 7 people here now so lets get her down the steps and out to the truck while we bag her at a rate of 12 to 20 for now. Somebody would have been sent to retrieve her chart and we will just take the whole damn thing. en route an IV NS, I would like an 18g with her, but we may be a little limited. I would have asked about a helicopter, but I have a feeling you were going to shoot that idea down, but? Does her chart have anything about her Hx? maybe CVA or HTN? did we get the chart? Hows she doing at this point? any changes with the bad a** vent that we have on board? continue with suction as needed, and reassess. Link to comment Share on other sites More sharing options...
fireflymedic Posted July 12, 2008 Author Share Posted July 12, 2008 first of all is this confirmation that this is our only pt? "Your partner finally returns with an aide who says "oh crap, that's her" and runs off." If so, cancel the inbound BLS truck! ECHOBURGER has an OPA in and bagging, lets get her suctioned out and get her intubated, we got what 7 people here now so lets get her down the steps and out to the truck while we bag her at a rate of 12 to 20 for now. Somebody would have been sent to retrieve her chart and we will just take the whole damn thing. en route an IV NS, I would like an 18g with her, but we may be a little limited. I would have asked about a helicopter, but I have a feeling you were going to shoot that idea down, but? Does her chart have anything about her Hx? maybe CVA or HTN? did we get the chart? Hows she doing at this point? any changes with the bad a** vent that we have on board? continue with suction as needed, and reassess. Okay, I like your thinking sleepy - suction started with hand vac which we carry in our jump bag - yeah they suck, but they work okay in a pinch. You go to intubate, the patient and they are clenched. FYI (RSI is an option if you want it) Sorry about the chart, you never did get it - just outta luck there. Patient is now boarded and out in the truck. I know you all want a helicopter so bad you can't stand it, but do you REALLY think you're gonna fit a 400 + lb patient in a little bell 407 which is what alot of the locals around here fly? Uh no. So sorry on that, you get this one one your own. Now let's get down to the nitty gritty - what's going on with this patient? What other interventions you gonna do to benefit ? Link to comment Share on other sites More sharing options...
letmesleep Posted July 12, 2008 Share Posted July 12, 2008 Wait a second there chief, RSI the biggness and stick a tube in her face....umm in case some reporter is trolling this, thats a good thing! How did the Pt do with an advanced airway? No, big deal about the helicopter, if what I think is wrong with her, theres a good chance that it won't matter much any ways. She may be looking at long term rehab or a hospice. so, any changes? Link to comment Share on other sites More sharing options...
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