Jump to content
usmc_chris

Dizziness with Fall

Recommended Posts

Look, I'm not trying to piss off anybody. As has been mentioned by someone else in this thread if we're going to have an intelligent discussion about this we all need to be speaking the same language.

I looked, before I asked, for possible explanations of the abbreviations in question. I didn't find anything that really fit. So I asked.

Mike, I did the same, I looked and didn't find anything on Google that showed the abbreviation of SMR to be spinal motion restrictions.

I also still am trying to find what COA means

I have no problems with abbreviations but if I do not know what they are I will look them up and then I will make notice that I don't knwo what they are.

Rock, I know you want this to progress but there are some pretty smart people on this thread (I include myself) that didn't know what SMR or COA or COG meant and your links to Stedman's really didn't help the issue, it provided 1 out of 3 of the abbreviations in question. But I do have a link now to go look up abbreviations that I am unsure of and I do than you for that.

Share this post


Link to post
Share on other sites

COA = Course of Action maybe?? It fits though.

COG = Cognitive I am assuming

SMR = Spinal Motion Restriction otherwise know as Spinal Immobilization, again I assume

Never liked acronyms unless they are widely know such as c/o, w/o, PEARL, LOC, IV, IM, IN, ect ect. The time saved is easily lost in translation such as in this case.

In this case I would be checking the ABC's first and foremost (action based on findings) then asking witnesses to find out just what the hell happened, if witnessed that is. Without the witnesses I would be looking for possible fall points, such as ladders or ledges. Without those present I would assume a standing fall and take appropriate action based on my trauma assessment. Now based on my protocols we would be boarding and collaring (don't you love places without spinal clearing protocols) and I would get an airway going if necessary or possible.

From this point on it will all be based on my findings same goes for transport.

Share this post


Link to post
Share on other sites

Actually he was at church, so maybe he had a vision and it freaked him out so much that he fainted, I've seen it happen.

Share this post


Link to post
Share on other sites

SMR: spinal motion restriction.

COA: Conscious, alert, oriented

COG: cognitive

Wow! I didn't realize I was going to open a can of worms! All I was trying to do was get into the spirit of the thread. I actually enjoy these. Guess I'll need to spell everything out in the next one.

I was simply asking all the same questions when I deal with any trauma, no matter how major or minor. I follow that head-to-toe method of assessment. It is something I learned in ITLS (International Trauma Life Support- in case there is any confusion!) :clown:

So, everyone, can we get back to the thread? I really want to see where this goes. I certainly wasn't trying to derail it.

Share this post


Link to post
Share on other sites

Keep in mind we have providers from all over the world on this site, so we generally stay away from abbreviations.

Share this post


Link to post
Share on other sites

I'm learning that.....

Teaching point for myself.

Share this post


Link to post
Share on other sites

And now to bring the thread back on topic. Sorry it took me so long to respond; I was in the field for drill weekend (and I thought the stupid thing would email me if there were any replies)

You grab your equipment and approach the patient on the side walk. As you approach, you notice that the fire department (BLS first response) has arrived but are standing around the patient with confused looks on their faces, looking to you for instruction, and nothing has yet been done. The patient's mother is at his side, generally in the way, yelling at you to do something and that she's a nurse. You are able to obtain a more accurate history from her, she states that as they left the service the patient stated he was dizzy then suddenly collapsed. She states that his only known medical history is hypertension, he takes Lisinopril 10mg once a day, and he has no known allergies. He fell backwards from standing and struck his head on the sidewalk.

As you are able to clear enough of the crowd to see the patient, you discover that he is actively seizing, and is profoundly diaphoretic. The seizure ends (duration approximately 90 seconds) as you kneel at his side. Rapid trauma assessment is unremarkable for gross deformity or bleeding however the patient is severely post-ictal and unable to verbalize any complaints or responses to palpation / physical exam at this time. Pupils are approximately 6mm and sluggish but reactive. Peripheral pulses are rapid, extremely weak, and thready. You instruct the first responders to obtain vital signs, however they are unable to auscultate a blood pressure. BSL is 116 mg/dl.

You (I) am an idiot and left the monitor in truck, about 15 feet away. What is your next course of action?

Edited by usmc_chris

Share this post


Link to post
Share on other sites

Immobilize and get the pt into the ambulance and out of public view as soon as possible. Strip him and put on the monitor. Have your (hopefully) competent partner get a real set of vitals.

Share this post


Link to post
Share on other sites

Pt is stripped to the waist, placed in a c-collar, and full spinal precautions are taken. During this you manage to place one 16ga IV, saline lock, in the pt's right AC. Pt is subsequently moved to the ambulance.

Pt is now conscious but remains lethargic, is responsive to verbal stimuli but seems to be oriented. Pt c/o dizziness but denies other complaints including chest discomfort or shortness of breath.

GCS - 14 (3/5/6)

BP - 72/54

P - 100

R - 32 / irregular and shallow

SpO2 - 90% RA

You place the patient on the cardiac monitor. Rhythm shows a regular sinus rhythm with a rate of 100-110, however multiform PVC's are also noted at a rate of 10-15 per minute. Pt still has a palpable radial pulse, corresponding to the rhythm displayed on the monitor however it is extremely weak. Pt remains profoundly diaphoretic.

Share this post


Link to post
Share on other sites

Talk to, or have your partner talk to the mother.

What were the events leading up to the collapse? Was it just a complaint of dizziness? For how long?

How has he been for the last several days? Sick? Compliant with his meds? Eating/drinking normally? Any abnormal events or complaints before today?

Tell me more about the collapse and seizure. Did he immediately seize? If so for how long? If there was a gap between falling and the seizure, how long, and what was the patient's status during that gap?

What is the patient's normal mental state?

Talk to the patient.

Does he remember the episode?

Any previous episodes, or similar episodes?

Does dizzy mean the room is spinning, or he feels like he's going to pass out?

And all of the questions asked of the mom.

Tell me more about the lethargy. Is he fully lucid? Coherent? How responsive to verbal is he? (responds to a normal speaking voice, a loud voice, needs to have his name called to respond, needs to have questions repeated) What happens when you stop talking/stimulating him?

How irregular are his respirations? Are there periods of apnea? Are they all equal in depth?

Physical exam

Neuro exam

12-lead

Lung sounds

If the distance between hospitals is equal then he's going to the level 1 regardless.

Share this post


Link to post
Share on other sites

×
×
  • Create New...