DartmouthDave Posted March 25, 2013 Share Posted March 25, 2013 Hello, You are dispatched to a suburban home for a 47 year-old female found unresponsive by her husband. The scene is safe and you are greeted by the patient's husband. He tells you that he has been out of town for the last 48 hours for work. When he came home today he found his wife laying on the bedroom floor. When you enter the bedroom you hear gurgling respriations and the patient appears pale and gray. Good luck 1 Link to comment Share on other sites More sharing options...
scubanurse Posted March 25, 2013 Share Posted March 25, 2013 (edited) LOC? Open up the airway--breathing improved? Pulses present distally? (get a good idea of BP) Monitor (ECG?) O2 Glucometer check? Any relevant medical hx? Allergies? Meds? Last time he spoke with her? ETA: I would also probably throw two large IV's in her as soon as feasibly possible and call for potential back up depending on what all I think is going on... if she's about to code I need more people. Edited March 25, 2013 by Kate_826 Link to comment Share on other sites More sharing options...
MariB Posted March 25, 2013 Share Posted March 25, 2013 (edited) Suction, call back up. History of diabetes? Glucose check. Can she breathe on her own? Titrate 02, non rebreather, prepare to vent . What's her responsive to pain? Edited to add, call for intercept. I don't like this feeling one bit. Is she clammy, sweaty? Has her BP tanked? Asthmatic? Cold is in the title. What's her skin temp? What's the home temp? Known allergies? Heart trouble? Pertinent history. Edited March 25, 2013 by MariB Link to comment Share on other sites More sharing options...
Chief1C Posted March 25, 2013 Share Posted March 25, 2013 Empty pill bottles? ^ and that other stuff Link to comment Share on other sites More sharing options...
island emt Posted March 26, 2013 Share Posted March 26, 2013 (edited) Vitals including bilateral BP's GCS in addition to all the above. HX of hypertension? HX of Seizures? HX of stroke? Cardiac HX? What prescriptions is she prescribed ? is she normally compliant Possibility illicit drug use? Core temp? Edited March 26, 2013 by island emt Link to comment Share on other sites More sharing options...
DartmouthDave Posted March 26, 2013 Author Share Posted March 26, 2013 Hello, You enter the bedroom and and suction thick secretions and dried pill fragments. During the suctioning there is no cough, gag, eye opening, or movement (GCS 3/15). Her pupils are fixed and dilated at 4mm midline. Her respiration are slow and irregular. Her skin is cold to the touch and you can feel a very weak carotid pulse. You partner quickly attaches her to the monitor. Her SpO2 is 84% with a HR of 35 - 40. Look like a sinus bradycardia with a 1st degree block. Her BP is 70/P. A quick BGL is 8.7 mmol/L. Her husband say he was away on a business trip for the last 2 days. He hasn't spoken to or texted his wife for two days because they had a fight. She has a history of MS, HTN and anxiety. She has recently recover from a major depressive episode. But, she has been angry about her MS and has been drinking too much. He is unsure of what medications she is currently taking. Thank you, D Link to comment Share on other sites More sharing options...
HellsBells Posted March 26, 2013 Share Posted March 26, 2013 No pill bottles around? Lets continue suctioning and support resps with 12bpm on the bvm, perpare to intubate. Probably should be considering pacing her at this point as well. Link to comment Share on other sites More sharing options...
DartmouthDave Posted March 26, 2013 Author Share Posted March 26, 2013 Hello, The husband runs to the bathroom to collect his wife medications. He can't find all of them but there is an empty bottle of Baclofen and Effexor (filled two days ago) and he tinks most of her Ativan are gone as well. An OPA is inserted and you start to ventilate her with a BVM. With an adequate seal and good technique you are having a hard time to ventilate her. Her breath smells of ETOH and the pills and secretions have been suctioned out. Her SpOs creeps up 90-91%. Her left arm was pinned under her body and feels hard and firm to the touch. The rest of her body is flaccid and cold. Her temp is 33.4 C. A second ambulance is on route to give you some more help. Cheers Link to comment Share on other sites More sharing options...
MariB Posted March 26, 2013 Share Posted March 26, 2013 OK, I would say screw it, if my medic wasn't with me I would load her and intercept for my paramedic assist. I would put her on her side, hoping for vomit, preparing to remove the opa if she does with suction ready. Keep her covered with heat on in ambulance. Have hospital on alert with heli on standby (small hospital). 12 lead to send to ER and ready for my Paramedic.. Continue assisted ventilations with BVM with high concentration O2. Have IV set up ready and paramedic bag out. And lights and sirens. This is why I do not want to end my education at the EMT level. 2 Link to comment Share on other sites More sharing options...
scubanurse Posted March 26, 2013 Share Posted March 26, 2013 Intubate to protect the airway. Let's get rolling to the ER also... probably some atropine and get some pacer pads/defib pads on (not to do anything yet) to get her heart going and incase she decides to arrest. Can you guys do NG tube suctioning? IF so, drop that after you get a tube. Link to comment Share on other sites More sharing options...
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