Unexplained Illness (Something doesn't seem right...)

[p3medic]

administer 2mg atropine and 600mg pralidoxime IM, and consider a benzodiazepine, and transport to closest facility. This gentleman is exhibiting classic signs of organophosphate poisoning and should be treated accordingly.....and decon him first too....

[Richard B the EMT]

Eydawn and I seem to be following the same path.

Have we had him expose his body or legs, to see if there is any skin reaction to whatever he may have come into contact with? What about the dog (don't touch, either you'll expose yourself to the chemicals that might be on the dog, get bitten, or both).

Gross decontamination might be attempted with either the regular shower, or a garden hose, prior to arrival of an engine company, but there could be possibility of the unknown stuff being water activated.

I'd also attempt the hose decon outside of the house, so the patient won't be stepping back into the contamination by walking out of the shower onto contaminated flooring or carpeting.

Reminder: I am BLS.

[akflightmedic]

Anyone remember the acronym SLUDGE?

[itku2er]

Anyone remember the acronym SLUDGE?

Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Distress and Emesis

[akflightmedic]

Very good Teri.

I was trying to jog memories for those who were still unsure of the diagnosis.

[reaper]

That was first thought after she stated that both had fallen in ditch. With the heavy rains, it would be runoff. Most likely from a nearby farm. Fertilizer runoff from the fields.

[Canadian Caesar]

(The scenario is being based on the majority rule as far as treatment decisions, so do not think I am ignoring your idea if I do not use it. I am simply waiting for more people to back up your position so that the most people can get the most out of this scenario.)

Since all of you seem to be moving in a similar direction I will continue the scenario as follows:

While there is no farming taking place in the sub-division itself, the area surrounding it is popular for cattle ranching and various forms of agriculture. Although your patient does not remember any equipment or tankers, he admits that his walking route did take him outside the subdivision a fair distance and out among the more agricultural land. He is coughing more and more often now and is slurring his speech more pronouncedly. Due to his coughing and spitting he is having to remove the NRB more and more often.

- Thinking chemical exposure, you activate the local fire service. A Pump crew and 2 recue trucks with hazmat equipment are enroute. ETA 15 min.

- Based on the ETA of resources and your patient’s rapidly deteriorating condition you know you must act yourself. If he has been exposed to chemicals, you cannot risk contaminating yourself, your unit or the receiving facility. Once the patient has been decontaminated, then you will be able to safely asses and treat the patient. Taking appropriate measures and PPE to protect yourself, you decide to attempt decontamination yourself, you remove the patient’s clothing and double-bag it in plastic bags. You notice that the skin on his lower legs and buttocks appears slightly reddened and splotchy without true urticaria.

- You and your partner assist him to the shower where you proceed to decontaminate him with water so that you can continue your treatment.

- You leave your male partner to perform the decontamination while you go to set up the equipment in the unit and prepare for transport. On the way out you recall that you have yet to hear the dog bark even once since your arrival. Your curiosity gets the best of you and you decide to take a look in the pen on your way out the door. A quick glance confirms your suspicions; the dog is lying motionless with no movement as you approach. There are several puddles of vomit and urine combined with a single large loose bowel movement on the floor of the pen. The dog no longer appears to be breathing and its legs appear to be positioned rather stiffly.

- Your partner calls for you loudly to return to the shower. Upon entering you find the patient collapsed in your partner`s arms still semi-standing. The patient is complaining in 2 word sentences that it has become suddenly very hard to breath. He is consistently spitting and is unwilling to tolerate the NRB in this state. The patient has defecated himself (narrowly missing your nimble partner), and is now writhing in pain at the severity of the cramps. A quick pulse check reveals a now irregular pulse at approx. 100 bpm. Your partner states that he had just finished decon when the patient grabbed him and collapsed in his arms. The Pt vomits a small amount of bile on the floor as you and your partner hurry him onto the cot and into the back of the unit just as fire arrives on scene.

-Your partner initiates an 18g IV in the patients right forearm on the second attempt. He also re-connects the patient to the monitor via a quick 3-lead.

The patients most recent set of vitals is as follows:

HR: 112 with a few intermittent runs of V-tach every minute or so.

BP: 82/ 56

Resp: 28 and frequently interrupted by bouts of coughing, spitting and gasping to catch his breath. Upon reconnecting the SpO2 machine after the shower, you see sats have fallen to 81%

The patient is now having difficulty with instruction as he begins to panic. He removes the NRB to spit and the mask slips from his trembling grasp. He dry-heaves a few times and tries to catch his breath.

As the senior crew member, you have time for a few actions before getting the heck out of dodge.

A few things are demanding your attention:

The fire crew is on-scene and requesting information on the potential chemical and exposure, they are also offering their single most experienced EMT to assist you. The rest are trained as First Responders.

The airway management of the patient has been left up to you and your partner is beginning to show signs that he is overwhelmed by the sudden deterioration and in need of your guidance of what to do next.

It has also begun to pour... again... with lightning. :wink:

[itku2er]

Why did you do the IV's before you controlled the airway?

[Canadian Caesar]

The Pt has JUST stopped tolerating the NRB and removed it after your partner secured the line.

He has been compliant with it thus far, but now is in too much distress and spitting and vomiting too much.

[itku2er]

suction prn and tube him you can use succs but its risky to do but it does metablize fast in the liver. Iv is going give atrophine and haul ass to the nearest hosptial.