Just Plain Ruff Posted December 22, 2010 Share Posted December 22, 2010 You are dispatched to a nice home on a reported lady having a panic attack. ON arrival you are greeted by this womans husband and her daughter. They say that she has panic attacks all the time and this is the worst one ever. Police were not dispatched on this call to assist you. You are a EMT/EMT-P unit. Your next closest unit is 2 hours away by either mutual aid or your 2nd out unit which is out of the state on a long distance transfer. Helicopter is a 50-60 minute flight and your closest hospital is your base facility which is 100 beds and does have a cardiac center rating. It is 45 minutes away since you are way way out in the county next to the red barn where you missed your turn the first time. Get it - you are rural. your first responders are very basic - no emt's there but one of them can drive the ambulance. Go for it. Link to comment Share on other sites More sharing options...
mobey Posted December 22, 2010 Share Posted December 22, 2010 What is the scene like? Smelly? clean? dirty? etc Initial impression... Skin Alertness Personal hygene? Chief complaint? Would like a BGL and ETC02 if she will let us. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 22, 2010 Author Share Posted December 22, 2010 What is the scene like? Smelly? clean? dirty? etc - well kept, 7 bedroom, 12 bath house with 1500 acres and two pools - they are rich and clean Initial impression... very athletic woman. No pudgy marks on her Skin - pale diaphoretic Alertness - somewhat lethargic Personal hygene? - she just got out of the olympic sized pool. Chief complaint? tired and panicky - usually the panic attacks stop on their own but this one did not Would like a BGL and ETC02 if she will let us. - blood glucose is 120 you don't carry ETCO2(they were ordered, they arrived but no one has been trained on how to use them) Link to comment Share on other sites More sharing options...
co2rescue Posted December 22, 2010 Share Posted December 22, 2010 Hmmm. PMH. Meds... any stressors Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 22, 2010 Author Share Posted December 22, 2010 Hmmm. PMH. Meds... any stressors PMH - negative recent cardiac workup. No stressors - she's a typical Housewife of New Breckenshine (She is a very pretty lady) She is on a SSRI for what the physicians says is anxiety She is saying she's feeling worse, getting a little green around the gills. Link to comment Share on other sites More sharing options...
Chief1C Posted December 22, 2010 Share Posted December 22, 2010 Cheating. Cheating. Rural... Hell, I have to wait 30 minutes for a paramedic. Go outside and make sure the Cadillac is still running; then land a helicopter in a field of the 1500 acres. Link to comment Share on other sites More sharing options...
Underdawg3ate1 Posted December 22, 2010 Share Posted December 22, 2010 How is the pt mental status like? Is she excited, aggitated, combative against her family, or is she going all out ape cuss? (combative or ape cuss gets PD dispatched for me.) If excited or agitated I cautiously approch her and if she's seated I'd take a knee or sit next to her. First I'd introduce myself and my partner(s). Ask her what is going on today and what brought us out here. Of course in a calm and friendly tone. While I have my newbs check vitals, I'd assess her respiratory rate, ask if she's having pain anywhere. Check for Carpal Pedal Spasms, skin color, level of alertness, obtian pmh, meds, allergies, and any recent changes in her medication. If she's hyperventalating, I'd try to coach her on slowing down her breathing. Ask what hospital she would like to go to, if she doesn't want to go I'd try my damndest to get her to go since this is the worst attack she's had. If she agrees, I'd have my newbs package her up and get her into the ambulance while I'd talk to the family. I'd ask the spouse if she was under any extraordinary stress lately, recent deaths, life changing events, drug /booze abuse (came off of a high/relapse) and when the last event was. I'd also try to gather any remianing demographics just in case she becomes uncooperative while en route to the hospital. Drive cold to the hospital. While en route, I'd keep the pt as calm/at ease and comfortable as possible. I'd ask her the same questions I asked her spouse to see if I get any different answers. I'd also have her on 2 lpm of o2 via a NRBM until her breathing is down to normal range. Monitor vitals and engage her in conversations. I'd monitor her pain if she had complaints of pain (if she described any cardiac type pain with or without cardiac history we'd be going hot to the hospital-not wasting time for a medevac or ALS). Contact the hospital with what I get and do an ongoing assessment until we arrive. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 22, 2010 Author Share Posted December 22, 2010 How is the pt mental status like? Is she excited, aggitated, combative against her family, or is she going all out ape cuss? (combative or ape cuss gets PD dispatched for me.) - she is lethargic If excited or agitated I cautiously approch her and if she's seated I'd take a knee or sit next to her. She is not agressive at all, as a matter of fact she is lethargic - did anyone say lethargic?First I'd introduce myself and my partner(s). Ask her what is going on today and what brought us out here. Of course in a calm and friendly tone. You have introducedd yourself While I have my newbs check vitals, I'd assess her respiratory rate, ask if she's having pain anywhere. Check for Carpal Pedal Spasms, skin color, level of alertness, obtian pmh, meds, allergies, and any recent changes in her medication. If she's hyperventalating, I'd try to coach her on slowing down her breathing. Her vitals are as follows - BP 80/40, pulse 250+, resp rate of 12 skin color pale and diaphoretic, pmh as described above in a earlier post, no allergies and only on a SSRIAsk what hospital she would like to go to, if she doesn't want to go I'd try my damndest to get her to go since this is the worst attack she's had. If she agrees, I'd have my newbs package her up and get her into the ambulance while I'd talk to the family. I'd ask the spouse if she was under any extraordinary stress lately, recent deaths, life changing events, drug /booze abuse (came off of a high/relapse) and when the last event was. I'd also try to gather any remianing demographics just in case she becomes uncooperative while en route to the hospital. She doesn't care what hospital she goes to, she is lethargic Drive cold to the hospital. While en route, I'd keep the pt as calm/at ease and comfortable as possible. I'd ask her the same questions I asked her spouse to see if I get any different answers. I'd also have her on 2 lpm of o2 via a NRBM until her breathing is down to normal range. Monitor vitals and engage her in conversations. I'd monitor her pain if she had complaints of pain (if she described any cardiac type pain with or without cardiac history we'd be going hot to the hospital-not wasting time for a medevac or ALS). Contact the hospital with what I get and do an ongoing assessment until we arrive. Your ambulance is ready to go. Link to comment Share on other sites More sharing options...
Chief1C Posted December 22, 2010 Share Posted December 22, 2010 I wasn't kidding.. Fly her. And if ur using a NRB like a paper bag, at least use 6LPM. Link to comment Share on other sites More sharing options...
mobey Posted December 22, 2010 Share Posted December 22, 2010 Is she lethargic? Need a 12 lead STAT.... Love that term, STAT We need a count of her meds, make sure we are not dealing with a ..... well, Ill wait to start throwing out DD's. Any Hx of SVT's? O2, IV please. Start bolusing fluid (as long as the lungs are clear) Link to comment Share on other sites More sharing options...
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