chbare Posted July 1, 2009 Author Share Posted July 1, 2009 Hmm ok lets get him on a board and collar, wait a minute and see if trismus lightens up and we can pop in an OPA otherwise drop in an NPA, do a quick RTA and get him in the bus You note continued trismus. SPO2 increases to 92% after inserting the NPA and the snoring resolves. No additional information from the RTA with the exception of diaphoresis. Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted July 1, 2009 Share Posted July 1, 2009 so in the ambulance now.... BP, Pulse, temp, BGL, Pupils, Air entry sounds. 2 I.V.'s, Get rid of the cloths. Cardiac monitor. Examine for needle marks, How fast was he moving? Link to comment Share on other sites More sharing options...
chbare Posted July 1, 2009 Author Share Posted July 1, 2009 so in the ambulance now.... BP, Pulse, temp, BGL, Pupils, Air entry sounds. 2 I.V.'s, Get rid of the cloths. Cardiac monitor. Examine for needle marks, How fast was he moving? Speed per prior post, IV's in place, sinus tachycardia lead II, Diminished lung sounds throughout, no needle marks, BGL: 1.3 mmol/L or ~22 mg/dl. Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted July 1, 2009 Share Posted July 1, 2009 lets give him 100ml of IV glucose and see if we can't perk him up a bit Link to comment Share on other sites More sharing options...
chbare Posted July 1, 2009 Author Share Posted July 1, 2009 After a bolus of 50% Dextrose in water, you note a BGL of 8.8 mmol/l or ~160 mg/dl. You also note decreased diaphoresis, decreased heart rate to 88, and a BP of 150/100. The respiratory rate remains rapid ~24/ min. However, there is no improvement in mental status and the patient continues to have the trismus. Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 1, 2009 Share Posted July 1, 2009 Assessments: Can I have condition of pupils? Any signs of seizure activity (per witnesses or oral trauma)? What is his GCS score? Neurovascular status of each extremity (pulses and withdrawal x4) ? Breathing was irregular. Did it fit any common respiratory pattern, such as Cheyne-Stokes? Interventions: I want to keep this patient warm with blankets. We should be en-route to the trauma center. Considerations: Herniation. Though still possible, pulse is not pointing it at this time. Other underlying medical conditions. RSI, though will hold off until I get more information. Nasal intubation, though I want to see what his trend is. So far trend seems to be improvement after interventions, but still critical. Will wait to hear more. Link to comment Share on other sites More sharing options...
zippyRN Posted July 1, 2009 Share Posted July 1, 2009 this is yelling sod the sugar in relative terms and start worrying about what is going on in side this guy's head Link to comment Share on other sites More sharing options...
Jeepluv77 Posted July 1, 2009 Share Posted July 1, 2009 Also consider giving thiamine with the d50. Does he show any signs of being an alcoholic? If he has identification, maybe ask the police to see if he has priors that could yeild clues(dui, possession, etc.) Also, nearby hospitals may have info on him. I saw were there was an NPA inserted, but not how we are delivering o2 for him. With the rate that high he may need to be bagged down. Also, with that hip I'd use the scoop not board. You stated he had diminished lungs sounds. Do we hear any adventitious sounds or is it more likely due to the shallow volume? I was wondering, we were told not to give d50 with a possible intracranial bleed which is one of the things I'm considering right now. Apparently it can cause necrosis in the cranial vault because of the bleed. Is there truth in this, and if so is it just a judgement call? Link to comment Share on other sites More sharing options...
chbare Posted July 1, 2009 Author Share Posted July 1, 2009 D50 may be harmful with a head injury; however, you have to treat a blood sugar of 22 mg/dl. So, are people thinking about going down the route of RSI? In addition, what ortho problem should you suspect? Take care, chbare. Link to comment Share on other sites More sharing options...
spenac Posted July 1, 2009 Share Posted July 1, 2009 (edited) Yes we need to secure an airway. So we will need to sedate and paralyze. Versed at 0.1mg/kg. Then Vecuronium 0.1mg/kg. Does this relax the trismus allowing me to intubate? The restricted mouth opening can be due to either the involvement of temporomandibular joint or pathology of muscles which are responsible for mouth opening. Any signs of penetrating trauma to face/neck? Edited July 1, 2009 by spenac Link to comment Share on other sites More sharing options...
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