FireEMT2009 Posted July 12, 2011 Author Share Posted July 12, 2011 Oh jeez, I suddenly realized my mistake. Sorry, guys, I haven't reviewed this stuff in a while--what was I thinking? Let me go ahead and get my head out of my ass for a second and then we'll go ahead and give this guy a man size dose of atropine. Let's go with 2 mg and keep suctioning those secretions, we can give another albuterol as well. Beiber, I was wondering why such a low dosage but I gotcha now. 2mg are now in and the secretions have dried up a little. Albuterol has been administered and wheezing is very very faint now. All vital signs are the same as before except for HR at SpO2 which are as follows: HR- 140 SpO2-99. What do you want next? Do you need more information? any other physical assessments you would like to do? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 12, 2011 Share Posted July 12, 2011 (edited) Assess his LOC. Assess his respirations (lung sounds, rate, depth). Assess his perfusion status (radial pulse, rate and quality; skin condition). Then let's have somebody get a set of vital signs (HR, BP, SpO2, BGL), I'll go ahead and do a quick head to toe. What do we have in terms of injuries? I was waiting to see if someone was going to jump on your for considering the above separate steps separately. I can't tell you how much I respect that you consider your initial impression, separated from your more thorough exam. You can learn a lot in the minute or two that it takes your partner to get an 'official' set of vitals. Also, man, you think that you have your head up your ass? OP poisoning and PPE didn't even enter my mind. Yikes...I was thinking of intubating so that I could quite screwing with his airway and wondering if I could remember how to mix dopamine at about the same time that you noted SLUDGE. That's cool as hell on your part, not so much on mine. Outstanding scenario as well as assessment! Man, this thread is really strong...It's truly the best of what's good about the City. Dwayne Edited to make me look like an even bigger idiot that I did when I originally posted. No significant changes made. Edited July 12, 2011 by DwayneEMTP Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 12, 2011 Author Share Posted July 12, 2011 I was waiting to see if someone was going to jump on your for considering the above separate steps separately. I can't tell you how much I respect that you consider your initial impression, separated from your more thorough exam. You can learn a lot in the minute or two that it takes your partner to get an 'official' set of vitals. Also, man, you think that you have your head up your ass? OP poisoning and PPE didn't even enter my mind. Yikes...I was thinking of intubating so that I could quite screwing with his airway and wondering if I could remember how to mix dopamine at about the same time that you noted SLUDGE. That's cool as hell on your part, not so much on mine. Outstanding scenario as well as assessment! Man, this thread is really strong...It's truly the best of what's good about the City. Dwayne Edited to make me look like an even bigger idiot that I did when I originally posted. No significant changes made. Why dont you give me a treatment plan for what you are thinking mixed in with beibers that way we can get a double medic attack on this guys condition? Link to comment Share on other sites More sharing options...
Bieber Posted July 12, 2011 Share Posted July 12, 2011 (edited) Beiber, I was wondering why such a low dosage but I gotcha now. 2mg are now in and the secretions have dried up a little. Albuterol has been administered and wheezing is very very faint now. All vital signs are the same as before except for HR at SpO2 which are as follows: HR- 140 SpO2-99. What do you want next? Do you need more information? any other physical assessments you would like to do? Yeah, I'm afraid I occasionally suffer from a minor case of head-in-ass syndrome. There's no known cure, but with treatment I should be able to live to a ripe old age. Let's just keep going with the 2 mg atropine until we either dry his secretions up completely or until signs of atropinization occur. It would have been nice to check his wallet and phone, but those are probably in the bag with the rest of his clothes. Oh! Why don't we send somebody to run inside real quick and look for any phone numbers for friends/family/work (especially work)? See if we can't get a hold of somebody and find out what he was exposed to. Let's get a sugar on him as well, and reassess his LOC. After that, and unless we can get any more information out of his neighbors or contact his work, I'd say let's get him rolling. I'm still thinking this is some sort of organophosphate poisoning, but there's a lot of unanswered questions. He was in his pajamas, so he must not have been at work, but we didn't find anything in or around his house? Is he a smoker? Any other medical history, meds or allergies we were able to get out of the neighbors or anything we found on scene? EDIT: Also, any recent history of illness? Travel outside of the country, even? Edited July 12, 2011 by Bieber Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 12, 2011 Author Share Posted July 12, 2011 (edited) Yeah, I'm afraid I occasionally suffer from a minor case of head-in-ass syndrome. There's no known cure, but with treatment I should be able to live to a ripe old age. Let's just keep going with the 2 mg atropine until we either dry his secretions up completely or until signs of atropinization occur. It would have been nice to check his wallet and phone, but those are probably in the bag with the rest of his clothes. Oh! Why don't we send somebody to run inside real quick and look for any phone numbers for friends/family/work (especially work)? See if we can't get a hold of somebody and find out what he was exposed to. Let's get a sugar on him as well, and reassess his LOC. After that, and unless we can get any more information out of his neighbors or contact his work, I'd say let's get him rolling. I'm still thinking this is some sort of organophosphate poisoning, but there's a lot of unanswered questions. He was in his pajamas, so he must not have been at work, but we didn't find anything in or around his house? Is he a smoker? Any other medical history, meds or allergies we were able to get out of the neighbors or anything we found on scene? EDIT: Also, any recent history of illness? Travel outside of the country, even? Beiber, His secreations have officially stopped with the administration of the 2mg. His wallet and phone was found in his clothes. Your crew walks in with a biohazard bag and collects the clothes on the floor. They state his floor and bed were all covered in this white looking powder, the same looking powder that are on his uniforms that were in the pile. The neighbor has no further information. You call the plant he works for and they tell you that he has been out the past two days with a real bad stomach bug. They tell you that he works in the pesticide department pouring a powder pesticide into the bags. Remember beiber the time is 2200. You find no ashtrays or cigarettes/lighters. His BGL is 130, and still unconscious.You find a number for a person named "Mom". You call and she tells you that he is only allergic to penicillin and milk. She also tells you that he has never been out of the state in his whole life. She also states that his age is 35 y/o. What other questions do you have? New vitals are HR- 140 RR 12 BVM SpO2- 99 BP 62/38 EDIT; for grammer and more information that is needed to continue scenario. Edited July 12, 2011 by FireEMT2009 Link to comment Share on other sites More sharing options...
Bieber Posted July 12, 2011 Share Posted July 12, 2011 Beiber, His secreations have officially stopped with the administration of the 2mg. His wallet and phone was found in his clothes. Your crew walks in with a biohazard bag and collects the clothes on the floor. They state his floor and bed were all covered in this white looking powder, the same looking powder that are on his uniforms that were in the pile. The neighbor has no further information. You call the plant he works for and they tell you that he has been out the past two days with a real bad stomach bug. They tell you that he works in the pesticide department pouring a powder pesticide into the bags. Remember beiber the time is 2200. You find no ashtrays or cigarettes/lighters. His BGL is 130, and still unconscious.You find a number for a person named "Mom". You call and she tells you that he is only allergic to penicillin and milk. She also tells you that he has never been out of the state in his whole life. She also states that his age is 35 y/o. What other questions do you have? New vitals are HR- 140 RR 12 BVM SpO2- 99 BP 62/38 EDIT; for grammer and more information that is needed to continue scenario. Well, I think that's all I got. It sounds like organophosphate poisoning to me, though hopefully we can get some samples of that powder to the hospital for analysis. At this point, I'm gonna go ahead and open up that line since his pressure's staying pretty low and bolus in 250 cc of NS and reassess his pressure and vitals and we'll just take him in. If the patient's breathing spontaneously and adequately now we can stop assisting ventilations. Link to comment Share on other sites More sharing options...
NYCEMS9115 Posted July 12, 2011 Share Posted July 12, 2011 Make sure you get the Insurance Information... If the Service doesn't get paid, you don't get paid... Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 12, 2011 Author Share Posted July 12, 2011 Well, I think that's all I got. It sounds like organophosphate poisoning to me, though hopefully we can get some samples of that powder to the hospital for analysis. At this point, I'm gonna go ahead and open up that line since his pressure's staying pretty low and bolus in 250 cc of NS and reassess his pressure and vitals and we'll just take him in. If the patient's breathing spontaneously and adequately now we can stop assisting ventilations. After initial bolus BP and pressure change, others stay the same. BP- 72/48 HR- 120. Well, I think that's all I got. It sounds like organophosphate poisoning to me, though hopefully we can get some samples of that powder to the hospital for analysis. At this point, I'm gonna go ahead and open up that line since his pressure's staying pretty low and bolus in 250 cc of NS and reassess his pressure and vitals and we'll just take him in. If the patient's breathing spontaneously and adequately now we can stop assisting ventilations. After initial bolus BP and pressure change, others stay the same. BP- 72/48 HR- 120. Make sure you get the Insurance Information... If the Service doesn't get paid, you don't get paid... Aflac pays you money! Link to comment Share on other sites More sharing options...
Bieber Posted July 12, 2011 Share Posted July 12, 2011 Let's go ahead and titrate our NS to try and get and maintain a pressure of around 90 systolic. Any changes in LOC? We'll call the hospital back for insurance information later! Link to comment Share on other sites More sharing options...
FireEMT2009 Posted July 13, 2011 Author Share Posted July 13, 2011 Let's go ahead and titrate our NS to try and get and maintain a pressure of around 90 systolic. Any changes in LOC? We'll call the hospital back for insurance information later! You drop another 750 mL, and he starts to groan. His blood pressure is now 89/60. You administer another 250 mL and he comes around and starts to wonder what happened and who you are. You are now at the hosptial and the ER docs and nurses have been handed care. The doctor comes in later and stated that your patient stated that he had been working in the factory and he got sprayed with the dispenser accidenty. He said he wiped off as much as he could.but still had it all over him. He went home that night and started having horrible diarrhea and vomiting. He just thought he was haivng a horrible stomach flu. The doctor stated that he had suffered severe dehydration along with the organophosphate poisoning. Doctor shakes your hand and congraduates you on your save. Congrats Beiber for working all the way thorugh the scenario! Thank you Dwayne and everyone else who commented. Link to comment Share on other sites More sharing options...
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