emt322632 Posted August 22, 2008 Share Posted August 22, 2008 Let's consider a brain bleed. Any recent falls? How long ago was the accident? Any neck stiffness? Nausea/vomiting? Cardiac monitor, IV, O2, nice easy transport to the hospital, pain management enroute. Link to comment Share on other sites More sharing options...
Timmy Posted August 22, 2008 Share Posted August 22, 2008 So his had fluids with nill output, c/o headache, brady and unusual spasmodic muscle contractions. Something funky going on with his electrolyte levels? Otherwise I'm with EMT322 on the treatment options. May also have some atropine on hand if the brady continues to decline Link to comment Share on other sites More sharing options...
zippyRN Posted August 22, 2008 Author Share Posted August 22, 2008 Let's consider a brain bleed. not yet , but a possiblity if mis managed Any recent falls? How long ago was the accident? no recent falls, original accident was 4 years ago no to either , but he feels a little better when he is laid o nthe ambulancetrolley after you have assited him cacross from his chair why do you want an IV in a normovolaemic, relatively hypertensive patient ? or just access only ... what do you want to give for pain ? and why you have a choice of 4 hospitals community hospital with ED 10 minutes away - east wards through town and the carnival crowds Levle 2 trauma centre I 20 minutes away - in the next decent sized town to the west level1 trauma centre 30 minutes away - to the east ( this hospital saw the patient at the time of his original accident but he was transferred for spoinal injuries rehabilitation after the neuro surgeons / ortho surgeons fixed his back and lower limb fractures) Level 2 trauma centre II 40 minutes to the west - this isthe spinal injuries centre te patient is known to andwherehe was rehabilitated following his original accident Link to comment Share on other sites More sharing options...
Timmy Posted August 22, 2008 Share Posted August 22, 2008 Possible Aneurysm??? Link to comment Share on other sites More sharing options...
emt322632 Posted August 22, 2008 Share Posted August 22, 2008 IV saline lock. Don't need to get too excited at this point. Locally I only have access to toradol or morphine for pain. With the unknown etiology of this pain (bleeder or not a bleeder) I'd opt for morphine rather than toradol. Does the community hospital have a CT? If not I'd say the closest hospital that does. If the community hospital does indeed have CT, the patient is stable enough to go there. Link to comment Share on other sites More sharing options...
zippyRN Posted August 22, 2008 Author Share Posted August 22, 2008 Possible Aneurysm??? cold a reaonable physical examination of the patient would indicate a probable cause for his symptoms Link to comment Share on other sites More sharing options...
zippyRN Posted August 22, 2008 Author Share Posted August 22, 2008 IV saline lock. Don't need to get too excited at this point. Link to comment Share on other sites More sharing options...
zippyRN Posted August 22, 2008 Author Share Posted August 22, 2008 So his had fluids with nill output, c/o headache, brady and unusual spasmodic muscle contractions. Something funky going on with his electrolyte levels? Otherwise I'm with EMT322 on the treatment options. May also have some atropine on hand if the brady continues to decline timmy examine your patient empty catheter bag does not equal no urine output ... Link to comment Share on other sites More sharing options...
itku2er Posted August 22, 2008 Share Posted August 22, 2008 any abdominal destention? Pain anywhere location and severity of the pain. How long ago did his symptoms start has he had them before? Last oral intake did he ride anything in the carnival? Link to comment Share on other sites More sharing options...
Timmy Posted August 22, 2008 Share Posted August 22, 2008 Last time the patient had bowels open? Link to comment Share on other sites More sharing options...
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