Canadian Caesar Posted August 19, 2008 Share Posted August 19, 2008 Dispatch Info: You are dispatched at 16:00 to the home of a 38 year old male complaining of sudden onset nausea, cramps, coughing and sweating. He walked his dog at noon and returned home for lunch. Shortly after eating his sandwich he began to suffer severe nausea, sweating and coughing fits. Concerned about the sudden onset of the symptoms, his first thought is that he might be having a heart attack. He calls 9-1-1 and begins to suffer some moderate SOB and cramps while talking to the dispatcher. Your response time is 20 min. Location: He lives on a small acreage in a upper-middle class subdivision of about 20 houses approx. 35 minutes from a large urban center. Patient Approach: You enter the house to find it spotlessly clean except for the muddy paw prints of a large dog on the carpet. You enter the kitchen to find your patient sitting on a stool still on the phone with dispatch. He is approx. 6”1’ and 175lbs. He is dressed in a mud-covered Nike jogging outfit and appears fit and healthy for a man his age. He appears to be in pain and short of breath due to coughing. “Don’t worry about the... *cough cough*... dog. The lady on the phone told me to...*cough*... put him away before you guys got here, so I did. He doesn`t really... *cough*... like strangers and normally goes crazy with his barking.” The patient raises a trembling arm to point to a mud covered dog laying quietly in a large pen in the corner of the kitchen. The patient seems very worried and is coughing uncontrollably every few words when he talks to you. Without crying out, his eyes begin to well up with tears as he talks to you. “I would normally have just seen a doctor... *cough* myself. But my dad died of a heart attack 3 years ago and I’m so worried... *cough cough* I have to piss so bad, but the cramps make it hard to stand and walk... *cough cough* You may begin your assessment. There is plenty of additional history and details available for the asking. Treatment Centers/ Backup: There is a modest community hospital in a town approx. 20 min East, while the large city hospitals are approx 45 min. West of your location. Air Rescue is occupied with a multi-vehicle collision on a highway and will not be available for at least an hour. A mixed volunteer/paid fire department is available from a nearby town. Another EMS unit is available and will take 20 min to respond. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 19, 2008 Share Posted August 19, 2008 Any headache, neck pain? Other than the sandwich, what else had he eaten that day, and when? Appearance of emesis? Any hx. of kidney or liver disease? Is the cough productive? If so, any blood? Any increase in pain upon deep inhalation or deep cough? Place on O2 12 L per NRM. IV NS TKO Vitals? Heart monitor. BGL when able to. In this case I'd draw a red top for lab at hospital to show what was going on right then. O2 sat? If covered in mud, did he fall while walking the dog? Or could the large dog have jumped on him, or pulled him down? Exactly where did he jog? Any toxins on farm? Very possible of a toxic exposure. Especially inhalation. Go to nearest facility. Try to nail down illness, transfer to larger hosp. if needed. Maybe by then the Air lift would be available. BTW: Very good scenario! Link to comment Share on other sites More sharing options...
itku2er Posted August 19, 2008 Share Posted August 19, 2008 what is med hx, allergies baseline vitals? Meds he is taking, what are his breath sounds? O2 sat, before placing on o2 then again after placement. Why were his clothes muddy? that will do for starters :wink: Link to comment Share on other sites More sharing options...
firedoc5 Posted August 19, 2008 Share Posted August 19, 2008 what is med hx, allergies baseline vitals? Meds he is taking, what are his breath sounds? O2 sat, before placing on o2 then again after placement. Why were his clothes muddy? that will do for starters :wink: Yes, O2 sat. before and after placing on O2. Thanx, Terri. Link to comment Share on other sites More sharing options...
itku2er Posted August 19, 2008 Share Posted August 19, 2008 Yes, O2 sat. before and after placing on O2. Thanx, Terri. Well I am waiting on Julian to give us more info. You are right its a good senerio YW btw see I am good for something :twisted: :twisted: :twisted: I would also like to know what he ate. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted August 19, 2008 Share Posted August 19, 2008 What did he eat? Did his dog get loose and did he pet him afterwards? ... R/r 911 Link to comment Share on other sites More sharing options...
Canadian Caesar Posted August 19, 2008 Author Share Posted August 19, 2008 As you begin your assessment, the patient answers your questions, tears streaming down his face and frequently coughing. You also notice he has begun to slur as he talks. He says he is from the city and is here house-sitting for his brother who is out of town. He works as a lawyer and decided to take a few days off for some R&R at his brother’s country home. He said he has been in the house for a few days now and was feeling fine until about an hour ago. The acreage is not a farm, and neither he nor his brother does any sort of gardening. It had been raining all day yesterday and he was anxious to take advantage of the break in the clouds to get in some physical activity. He decided to take his dog for a jog on the roads around the area at about 13:30. At one point his dog slipped away from him and chased a squirrel and ran down the road. After giving chase to his dog, the patient slipped and slid on his butt into the ditch were his dog soon followed him down. The ground was still quite muddy from the rain. This explains the soiled condition of the dog and clothes. He denies any injuries form the fall and says that he simply fell to his butt and slid down the embankment into the ditch. He climbed out and decided to return home for lunch and to clean up. He had just begun to make himself a sandwich when he began to sweat profusely and get cramps. Your initial assessment reveals the following: HR: 50 Regular, No Murmur, Good perfusion BP: 92/60 Resps: 20 with intermittent coughing. Stats at 83% RA and 94% on RNB which he is constantly removing to cough and spit then replacing the mask in between coughing fits. The spit seems to be only saliva, clear in appearance. Temp: 98.6* F 37* C BGL: 88 mg/dl or about 4.3 mmol/L CNS: GCS=15 A/Ox4 CVS: Radial Pulses Strong and Regular, Skin slightly pale and Very Sweaty. His clothing is quite damp. HEENT: Bilateral Miosis and Sluggish response. Chest: Scattered wheezing with equal air entry. ECG: Sinus Brad with a prolonged Q-Tc interval. Abdomen: Soft, non-tender. No rigidity, guarding or masses. Pt complains of cramps unaffected by palpation. Bowel sounds are present. He denies vomiting, hemoptysis, hematuria, bright red blood per rectum (BRBPR), chills, fever, headache, myalgia, arthralgia, or diarrhea. Pelvis: During your exam, the patient becomes incontinent of urine, this upsets him greatly and he tells you that he already been to the bathroom twice since he got back from his walk Extremities: A slight tremor is noticed in the patients left arm which he states has only just begun, transient fasciculations in both upper extremities. The only medical history that the Pt can think of is that both his father and grandfather died of Heat-attacks in their early fifties. The patient states that he goes for annual check-up's with his doctor and has had no other medical problems or reason to see him. The Pt denies any allergies or meds and states that he has been in good health and the last pill he took was some Tum’s antacid after he had taco’s for dinner the night before and got a little heartburn. He had cheerios this morning at about 10:00. Link to comment Share on other sites More sharing options...
itku2er Posted August 19, 2008 Share Posted August 19, 2008 Does positioning change change the breathing any at all making it easier to breath? Link to comment Share on other sites More sharing options...
Richard B the EMT Posted August 19, 2008 Share Posted August 19, 2008 The patient raises a trembling arm to point to a mud covered dog laying quietly in a large pen in the corner of the kitchen. “Don’t worry about the... *cough cough*... dog. The lady on the phone told me to...*cough*... put him away before you guys got here, so I did. He doesn`t really... *cough*... like strangers and normally goes crazy with his barking.” Hmm? As we in EMS are about as strange as one can get (lol), the dog should be trying to channel Cujo to either get at the EMS team, or go all defensive of it's property (the person). I'd say we have 2 patients, one human, the other canine. Of course, we'll concentrate on the human, and if the canine can be helped, we will. At one point his dog slipped away from him and chased a squirrel and ran down the road. After giving chase to his dog, the patient slipped and slid on his butt into the ditch were his dog soon followed him down. The ground was still quite muddy from the rain. This explains the soiled condition of the dog and clothes. OK, is any new building construction going on nearby, or farming? Both man and mutt slid into a ditch, and possibly are contaminated by an as yet unknown substance or substances, singly or in combination. Said chemical(s) might be either deliberately dumped in the ditch, or is rain wash-off from the surrounding area, going into the ditch, and it's muddy banks. Am I getting warm, J. P.? Link to comment Share on other sites More sharing options...
Eydawn Posted August 19, 2008 Share Posted August 19, 2008 I'm going with acute pesticide/chemical exposure leading to respiratory distress and other wonderful effects... First off, let's get this guy out of those clothes and have him rinse off in the shower, and get any nearby neighbors to come take care of the dog. We need to get the chemicals off him so they don't completely fubar our ambulance and so no one else gets exposed. Don't bother with clean clothes... blanket wrap will be just fine. Shouldn't take more than a couple of minutes... but he needs line of sight support until he's on the cot, in case he seizures/fubars on us. Put him on the cot, get going, get on the phone with the doc and get ready to do some heavy duty respiratory support. Establish an IV and get more medical history if he remembers anything else... Based on what I'm seeing, that's what I'd do. Did he see any barrels or tractors or trucks with liquid type stuff anywhere nearby? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
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