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

[jsadin]

I agree w/Terri. He's decon'd as good as he's going to be. Push your drugs, secure that airway and haul ass.

Anyone use the DUMBELLS acronym? Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm & Bronchorrhea, Emesis, Lacrimation, Laxation and Salivation. I find SLUDGE easier to remember.

[itku2er]

I agree w/Terri. He's decon'd as good as he's going to be. Push your drugs, secure that airway and haul ass.

Anyone use the DUMBELLS acronym? Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm & Bronchorrhea, Emesis, Lacrimation, Laxation and Salivation. I find SLUDGE easier to remember.

never used the dumbell but have the sludge that is how i lerned it.

[CBEMT]

I don't have RSI but I do have 10 Mark I kits onboard. He's getting as many as necessary to see improvement. Transport will be to my trauma center with a notification to get any homeless people out of the shower room and break open the decon trailer (NOBODY who's been contaminated enters our hospitals until the hospital decons them themselves, regardless what they got at the scene). Take Fire's EMT and ask if they can spare another member to drive. Another IV enroute, and maybe the combo pads too.

[Just Plain Ruff]

I'm gonna RSI the guy if I can but if not I'll try to nasally intubate him if he tolerates it but I'm betting he won't.

this guys gonna code shortly. This is a no-win situation.

did we give the 2pam and atropine?

[firedoc5]

As stated, tube, Atropine, open IV WO. Send fire crew to where he and the dog slid of water and soil samples. Have police completely barricade the house due to possible contamination there.

Rapid transport. Check status of air lift. If possible, intercept down the road. Unless that will take longer than your ETA by ground.

Sedate once tubed. Visteral 75-100mg. IM if carried for vomiting and cramps.

Oh, and call a vet. Unless it's too late for the dog.

[Richard B the EMT]

Oh, and call a vet. Unless it's too late for the dog.

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.

Sorry, my brother and sister animal lovers, the dog is DOA, as I read it in the text.

This is also my first time hearing the "Dumbell" acronym, as I was trained with "Sludge". Due to lack of need, hopefully to continue, I need reminders of it, so thanks.

[Doczilla]

I agree that this looks like a SLUDGE presentation. Agree with all the treatment recommendations regarding atropine and 2Pam. Because of the contamination, I would not try to fly the guy. Most flight services will balk at flying a hazmat victim, even if decontaminated in the field, and for good reason. The helicopter can't pull over and stop if the pilot's eyes start watering.

As I found out last week on an unfortunate patient with a pesticide mishap, atropine works wonders for this presentation. I don't think we need to break out all the Mark 1 kits. 1 or two should suffice, supplemented by the atropine in the drug box. 2 Pam is pretty expensive, as are the autoinjector kits, and he's unlikely to benefit beyond a couple of doses. If we're running out of atropine and he still needs more, then yeah, he gets all the Mark 1 kits.

If the dog was my own dog or a military or police K9, and there were no human patients, I would treat him. Otherwise agree that the dog is DOA. Probably some runoff from a field that was sprayed for pests.

Great case!

'zilla

[mobey]

I realize it is too late to ask but.....

If he passed any stored grain, there is a variety of chemicals to treat bugs that can trigger these same affects as seen in common agricultural pesticides.

The treatment for these however are the same. Atropine.

[CBEMT]

Unfortunately Doc the only way we carry 2pam is in the Mk I kits. I wish we carried more atropine IV, but "3 is the most we can give in a code so why would we ever need more than that?" :roll: :roll:

That said, we won't get into the lack of IV atropine in our WMD protocol in the first place. We're too dumb for anything but autoinjectors. :evil:

[Canadian Caesar]

Just wanted to say great job guys. I don't see much more reason to carry on any further with this scenario. I am very pleased with the way it turned out and I hope everyone had the chance to learn (or at least remember) something new.

Somebody mentioned running out of atropine. Another option would be calling for an intercept from the closest ALS unit for no other reason than to borrow their extra atropine. Even if you don't need the hands, they can certainly bring you drugs.

Another point that has been brought to my attention (rather vehemently) is that some people would feel entirely uncomfortable even assessing this patient until they have been decontaminated by Fire, regardless of the wait time until Fire Services arrival. Others are willing to risk decontamination themselves and feel that they would be able to do so with their own PPE at minimal risk to themselves.

There are experienced and respected practitioners on both sides of the issue and I think the topic could warrant further discussion if the forum wishes. I must stress that I am interested in BOTH sides of the issue.

The questions I would pose are:

In your opinion, what would constitute acceptable risk in this case?

What would be your deciding factors in risking the decontamination process yourselves?

Do you feel adequately trained and equipped to manage a specific case like the one that has been presented?

Would you even attempt it regardless of the patients condition and wait time?

There certainly comes a time when your safety and that of your partner becomes priority? Is this one of those times?