Unknown Unknown Unknown...Give it a try!

[EMSm0nster]

So what's the update? Unknown like the title?

Could this person have PEA?

[iMac]

Is that jackass drunk??? (...worked on a reserve a bit to long)

[paramaniac]

I concur with the previouly suggested assessment & management, with expeditious transport.

Focussing on the apnoea & specific causes,

Assuming the Airway is now patent we must search for the cause of the ventilatory failure, specifically considering the following,

1. CNS depression ( Narcotics/Alcohol/CVA/head inj etc)

2. Neuromuscular paralysis ( C-spine inj/ Organophosphates etc)

3. Breached integrity of Thorax ( Flail segment/ ruptured diaphragm/ Pneumothorax etc)

4. Ruptured Trachea/Bronchus etc

You need to supply the findings of the primary survey to illicit further diagnostic & management suggestions.

[CBEMT]

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.

Anybody considering flying a patient who's 16 minutes drive time from a Level 1 should have their license shoved straight up their @$$, forthwith and postehaste.

[clutzycowgirl2002]

I have to agree that initiating a flight would be a step best not taken. In my experience, you can drive there quicker than they can get off the ground...but to the patient at hand;

C-spine and LSB~bagging with LPA in place since I don't have the tag to intubate~get him in the rig and do a quick trauma assesment, BGL, full set of vitals, check for medic alerts, and begin transport. Possibly have ALS intercept if they are available and depending on what I'm finding in the rig.

I can't rule out trauma tho. We had a pt lying in a ditch last fall, reeked of ETOH, but came to find out he dived out of a moving vehicle at 40+~

So, now that this guy has been lying here for ten days letting us poke and prod him....anyone know how he turned out?

[EMTChris]

stabilize c-spine, Drop a tube, BVM 100% all the way in. The only thing to administer to this Pt is gasoline. Get him to the ED.

[Just Plain Ruff]

this is a primary example of someone posting a scenario and then vanishing while the posts are coming in

Do us a favor, if you post a scenario please follow thru and not vanish. It makes the scenario much more interesting.

[Asysin2leads]

There are a bunch of people on this scenario who are going to be writing "I will not think zebras" on the blackboard 100 times if they don't knock it off.

Venomous fauna??? Woodland creatures? Anybody ask if there is a strong odor of alcohol or how his pupils look? No gold stars for anyone.

Maintain C-spine precautions, board and collar, BVM with OPA. If he tolerates an OPA, prep to intubate in the truck. Otherwise go with an NPA and BVM. Check pupils. Strip to look for other injuries, get vitals. EKG, why not? Is there a car with a person sized hole in the windshield anywhere in the vicinity?

I say the odds are:

33% Drunk

33% Stoned

33% Smacked on the noggin

1% Cardiac/mystery plant/critter

[FormerEMSLT297]

Anybody considering flying a patient who's 16 minutes drive time from a Level 1 should have their license shoved straight up their @$$, forthwith and postehaste.

You know, I was thinking the exact same thing when i read the initial "trauma center is 16 minutes away." You figure, if the helo is at the trauma center,, then a 4 minute start up, and a 7 minute flight, you just saved hmm,,,,,, 5 minutes .. ????

[Bombera]

Well, I'm no expert yet, but I'll give this one a try.

Question: What are the whether conditions that caused the Lifelight heli not to fly? Is there water present in the ditch from rain?

I am BLS (actually still an EMT student), so I am assuming that my partner is the paramedic. I would drop an NPA because my partner's preparing to intubate and that will save him or her the trouble of taking the OPA out first. Then, I would start bagging the guy with a BVM with 15 lpm of O2 while my partner gets ready to intubate. If there is water in the ditch, I would perform an urgent move of the patient so that he doesn't drown in the water in the ditch. In fact, if there is water in the ditch, then the patient may also have water in his lungs. As soon as we get him tubed, I would transport him code 3 to the ER.

Take care!