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Sibbling down


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You are dispatched to a rough looking hood at 9pm for an unconscious called in by 5 year old who said he fell asleep watching TV and awoke to find his sister had done fallen down while mom and dad are out to dinner.

Having secured the ambulance with the trusty steering lock, you arrive on the second floor of the walk up to find two kids (one aged 5 and one aged 3) peaking out and crying over thier sister who is unconscious and cyanotic.

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All right start off with the basics.

Environment - Any hazards? Other people around other than the siblings? How rough a neighbourhood?

Mechanism - I'm not clear from your writing what I'm looking at. I'm I outside the apartment looking at the patient on the landing to the stairs or am I inside. Can I rule out trauma at this point?

Casualties - Anyone else hurt?

Assistance - None at this time.

How old does the sister look? How big?

Primary

How's her airway? (Consider adjunct) How's her breathing? (consider PPV, O2) Palpable radial pulse and what is it? Gross hemorrhage check?

(assuming I'm not doing CPR at this point)

Neck - JVD, trachea midline, DCAP BTLS, accessory muscle use and indrawing, subcutaneous emphysema?

Chest - DCAP BTLS, equal rise and fall (no paradoxical movement)? Auscultate in four quadrants (equal bilateral a/e in apexes and based, no adventitious sounds?)

Abdomen - Inspect (discolouration, bruising, pulsatile masses), palpate

Pelvis and Femurs - stable

Ankles - any peripheral edema?

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Actually what i enjoyed most about my old EMS job was precepting baby medics. You should have seen the look on their faces when i told them that they have to assess their patients without the use of a B/P cuff, cardiac monitor, pulse ox, or glucometer -- give me their diagnosis and probable treatment plan, and only then would they be allowed to play with the toys (especially the cocky ones who thought they knew a thing or two cause they passed their registry on the first go around).

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Pretty much quick assessment, and transport under implied consent. Request PD to the location for the other children. Walk up, any major bleeding found? Arouse to Verbal or Painful Stimuli? Look at Airway, Breathing. She's cyanotic, hi-flow O2, adjunct and bag. Check for a pulse? Radial? Carotid? Request ALS if not done so, and move to the hospital.

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Sorry, your are inside the apartment.

No obvious hazards, building and some of the people you encountered on the stairs look like they have seen better days. No crack dealers or gang bangers in sight.

No trauma and only one patient. One of the kids states his sister is 14, she looks like she weighs about 50kg (100lb).

Respiration is limited to agonal gasps. You can place an OPA but the airway is full of mucous. There is some localized edema around the mouth.

Monitor shows sinus tachycardia at 140 and decreasing.

You get the following information from the oldest child:

S - obviously unconscious

A - none

M - states his sister went to the doctor and got the "zebra"

P - unknown

L - unknown

E - she was watching TV with him when he fell asleep and woke up to find her KO'd.

Vitals are as follows:

BP 60/40

PR 100 and weak

RR about 4

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Any medical ID on the sister or in her purse? Epi pens, perhaps? First thing is suction. Hopefully I had the foresight to put the suction kit on the stretcher with the monitor...

Suction, place an OPA, if we have a paramedic with us, grab the airway kit and prep to tube... full head to toe, do we see any bite/sting marks, track marks, or other things that would give us a clue? Even though I can't interpret it, can we put a 12 lead on and see if anything pops out?

Meanwhile, let's ask the kiddos what the older sister's name is and look for any pill bottles around the house, with her name or not. Assistance would be good just to help wrangle the little guys and someone's gotta be responsible for them.

Any food or drink containers close to where this lady fell down? Any signs of poisonous ingestion (chemical odors, weird smells, localized burns)? Is it mucus in her mouth or vomit? What color is she?

Wendy

CO EMT-B

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