FVFD441 Posted April 25, 2006 Share Posted April 25, 2006 You are called to a residence for a 60 year old male complaining of difficulty breathing. You arrive on scene and notice a two store apartment building, Pt's, apartment is on top floor with 20 steep steps up to the door. you make your way up the step and notice that the steps are in poor condition and doubt that you will be able to use your stair chair due to the condition of the steps. In the house you find you patient in the back bedroom, down a narrow hallway. you start your assessment on this patient. you find your patient has a decreased mental status, his color is gray, excessive sweating, you also find JVD, Peripheral and Pulmonary edema, lung sounds are wheezing and course crackles in all fields. You pt patient on the monitor you notice a wide complex tachycardia at a rate of 230/ min. his pulse is faint, pulse ox reading is 61% on 3 liters of o2. his family states he has refused to be treated in the past. his weight is approx 350 lbs., His vitals are B/P 90/50, Pulse of 230, respers of 60 what is you next step in care for this patient? Link to comment Share on other sites More sharing options...
Callthemedic Posted April 25, 2006 Share Posted April 25, 2006 1st of all, congratulations for getting breath sounds on a 350lb pt! Saw the vitals at the bottom: resp failure.......intubate................one breath a second? BVM 100% assist Link to comment Share on other sites More sharing options...
akflightmedic Posted April 25, 2006 Share Posted April 25, 2006 You only asked the next step...mine would be calling for backup, cause I am not lifting that dude myself, especially when he codes. Link to comment Share on other sites More sharing options...
TechMedic05 Posted April 25, 2006 Share Posted April 25, 2006 Can we say "Cardioversion"? After that whole 'Call for help' thing. Link to comment Share on other sites More sharing options...
vs-eh? Posted April 25, 2006 Share Posted April 25, 2006 Are you posting this because he has refused treatment in the past? Because it is a pretty clear cut line of treatment... If so... 1) Who called 911? 2) It doesn't matter, he is a danger to himself now and falls under Mental Health acts. The argument can be made that he is not of sound mind to refuse treatment, due to hypoxia/hypoxemia, among other possibilities. The treatment is immediate cardioversion. He is the definition of "unstable". Get your airway roll out too... If he refuses simply wait outside till he arrests... Link to comment Share on other sites More sharing options...
Callthemedic Posted April 25, 2006 Share Posted April 25, 2006 Implied consent I think Link to comment Share on other sites More sharing options...
paramedicmike Posted April 25, 2006 Share Posted April 25, 2006 I'm with AK. The first thing I'd do is call for help. The second first thing I'd do is cardiovert. -be safe. Link to comment Share on other sites More sharing options...
vs-eh? Posted April 26, 2006 Share Posted April 26, 2006 Implied consent I think Nah...Implied consent is like "We need to give you this med, but first we need to start an IV", and the patient puts out their arm. That is implied consent. Implied consent is also treating a patient when they might not be able to refuse/appreciate the treatment (i.e. GCS 3, whatever) as long as it would be reasonable for an "average" person... Or is that presumed consent? Is there a presumed consent? I don't remember... This scenario stated that the patient has refused treatment in the past. Should the patient refuse treatment in this case, then he could be under the "self harm" flag as well as owing to the fact that he doesn't necessarily appreciate/understand the ramifications of his refusal (due to hypoxia/hypoemia). A "reasonable" person in a similar situation (baring no DNR or whatever) would consent to treatment. He refuses? Whatever, call a supervisor and/or police. I wouldn't wrestle with this guy or anything to force treatment, because then you would likely be (well you would) move this situation from a pre-arrest to an arrest situation. Whatever, just wait until he is so obtunded that he doesn't care, or until he arrests. Use the time, to prepare or something...probably won't be the easiest of intubations... Link to comment Share on other sites More sharing options...
AKmedik8or Posted April 26, 2006 Share Posted April 26, 2006 what is you next step in care for this patient? First step -- reassessment -- some where in this presentation something doesn't seem to add up. Either way shock him into something that does add up. The VS you have presented are unsustainable anyway you look at this. Get a Truck company enroute to start taking that back room wall down to pull your Pt from the second floor. Pray you've got some newbie 3rd rider for CPR. With any luck reassessment will provide a presentation with improved survivability. Link to comment Share on other sites More sharing options...
Callthemedic Posted April 26, 2006 Share Posted April 26, 2006 Don't know the AVPU but would assume, based on vitals, that he is not able to voice an opinion. A "P" at best. Actually, he seems end-stage except for the obesity, with his little useless gasps. I imagine the cannula's tongs long since clogged with snot have not delivered 02 to his brain in awhile. It's been awhile but I think it is complied. I'll look it up tomorrow if our OP doesn't show up. Link to comment Share on other sites More sharing options...
Recommended Posts