Unknown Unknown Unknown...Give it a try!

[EMS_Cadet]

You are siting at the dinner table with your partner when the pagers go off.

You are dispatched to a country road for an unconscious person of a delta response. Caller advises unknown age male laying in the ditch. Dispatch advises first responders are also enroute.

You mark enroute to the call.

You have an ETA of 11 minutes.

You arrive on scene. Scene is secure. No hazards present, except some occasional light traffic. First responders are handling the traffic.

You get all the expensive equipment out of the truck and walk down the ditch.

You see an older male laying in the ditch. You walk up to him. You idenify yourself and gently shake him (taking in mind c-spine). You get no response. You preform a sternal rub. No response. The patient is cyanotic. You do a jaw-thrust and determine the patient is not breathing. The patient does have a pulse.

You are on a fully stocked ALS ambulance. The nearest ER (which is also a level I trauma center) is 16 minutes away. Lifelight is grounded due to weather conditions.

Go get it kiddies!

[Callthemedic]

Would scene safety include no brush/cover in that ditch where venomous fauna would be?

Secure airway

BVM 100%

Rapid trauma assessment (to rule out and inspect the skin)

Contents of pockets,backpacks,etc

[medic001918]

I'll assume a "delta" response is an MVC of some kind? Remember when posting scenarios that we don't all follow codes, or the same codes for that matter. But I'll give the scenario a go. If the patient is cyanotic and not breathing, but has palpable pulses, then airway is among the highest priority while preserving c-spine precautions.

The patient is lying in a ditch, but is he lying prone? Supine? If he's prone, we'll log roll him while manually holding c-spine. Once the patient is supine, it's time to correct the issue of him not breathing by bagging via BVM with O2 along with the use of an OPA. The cyanosis and lack of respiratory effort would is of major concern and indicative of the need for intubation. Are there any secretions in the airway that we need to suction? The patient would immediately be intubated assuming adequate relaxation and someone manually holding c-spine during the intubation attempt. Once my airway is secure, the patient would be ventilated at a rate of approximately 12 breaths/min. What do the patients lungs sound like? Are they equal? Clear? Adventitious?

The patient would be exposed to look for any obvious injury and log rolled onto an LSB.

The monitor would be applied to the patient, so I'd like to know what rythem I see? Along with a full set of vital signs including blood glucose, pulse oximetry and ETCO2? Is the patients color improving after being intubated?

It's time to get going to the hospital on a priority transport. En route, I'd establish at least one IV w/fluids hanging at KVO (unless something indicates otherwise). I would try for a second point of IV access if time allowed and the patients condition remained without change. At this point, further assessment and supportive care would be indicated.

Also, as a side note of a truama center being 16 mintues away, lifeflight would not even be a consideration as it would only serve to delay getting the patient to definitive care, especially since there are no difficulties with extended extrication. Ground transport on a priority to the trauma center would be adequate for this patient.

Shane

NREMT-P

[vs-eh?]

"Delta" is part of the ProQA dispatch system, which I assume is fairly common throughout North America. It is just a priority level, not necessarily specific too any given call, though most delta's involve CP/SOB/unconsciousness/etc...

Why are people assuming that this is a trauma? I saw nothing in the call details that would indicate that, not that details mean anything anyway...

I want to hear the physical exam. If there is no injury that would be consistent with causing unconsciousness, I would be looking at other things...

The jaw thrust has apparently opened his airway nicely. Augment that with an OPA and NPA for now along with assisted vents and your A+B are taken care of. An OPA and NPA will adequately manage this patient for now.

I WOULD NOT be intubating this patient prior to getting a BS.

I'll wait.

[ERDoc]

I'll let you guys talk about the field work, but once in the ER we need FS, pulse ox, rectal temp. A good physical exam would be helpful. Then we need to procede with an AMS workup and I would pan scan as we cannot rule out some form of trauma. If there is nothing we can fix immediately (hypoglycemia, narcotic OD), then this guy has got himself an 8.0

[ERDoc]

Delta is used for priority dispatching. Check out this link to get our local version of Medical Priority Dispatch codes.

http://www.fordyce.org/scanning/scanning_i...cfcodes.html#A6

[hammerpcp]

Why are people assuming that this is a trauma? I saw nothing in the call details that would indicate that, not that details mean anything anyway...

I want to hear the physical exam. If there is no injury that would be consistent with causing unconsciousness, I would be looking at other things...

The jaw thrust has apparently opened his airway nicely. Augment that with an OPA and NPA for now along with assisted vents and your A+B are taken care of. An OPA and NPA will adequately manage this patient for now.

I WOULD NOT be intubating this patient prior to getting a BS.

I'll wait.

I would probably be taking spinal precautions, initially at least, as well. It takes only a couple of extra seconds when you have that many hands on scene, and like the title says.......Unknown, unknown,unknown. This individual could be unconscious due to drugs not trauma, but he also could have been tossed out oaf a moving vehicle.

[medic001918]

Why are people assuming that this is a trauma? I saw nothing in the call details that would indicate that, not that details mean anything anyway...

How could one assume that it's not a trauma? It's a CYA issue in this case. There doesn't appear to be anyone around to tell you a story. And traumatic injury can't be ruled out, so c-spine precautions would be initiated.

As far as the delta thing, we commonly use plain english at the service that I work for so I'm not familiar with the definitions. Just a difference in area I guess. I'd like to hear some information regarding the questions from assessment...we'll see where it goes from here.

Shane

NREMT-P

[Callthemedic]

Unconciouse pt with no witnesses = r/o trauma

Rapid trauma assessment is quick and would tell you so much in a short time

You would get a look at the skin and feel for something out of place.

Your senses are the quickest diagnostic tools to use.

[Arachne]

BLS:

Request ALS if not already en-route, NPA/OPA, ventilate with 100% O2 via BVM. Rapid trauma assessment. Backboard and collar (even if this has a medical origin, he somehow got into the ditch and we don't know how...also, it makes him easy to move around and if he's not breathing, he may end up requiring CPR and you'll need him on a hard surface). Vital signs (including BG if BLS is permitted in the area), rapid transport. Intercept with ALS if they're not on-scene by the time he's loaded.

Any indication of how he got there? Tire tracks? Footprints? Smells (such as etOH)? Who found him? How far is he from a house or business or someplace he could have walked from? Track marks? Medic alert jewelry? Anything useful in his pockets or wallet (if you have someone who can take the time to check)? Have police/first responders checked to see if there's anyone else in the area or a car deeper in the woods?