cidefex Posted July 16, 2006 Share Posted July 16, 2006 It is 2 am. You are dispatched to a MVC. Vehicle has rolled after hitting ditch. A sixteen year old male has hit the ditch and rolled his car at about 45 mph. There is only one pt and your scene is safe. The FD have the patient extracted upon arrival. You see there is lots of trash and debris in the car. Windshield is missing. No real deformity to steering wheel. Pt is A&O X4. Pt is c-spined and on a backboard. The only injury you see is a laceration above the pt's right eyebrow, that is easily controlled with some 4x4's. Patient states his head hurts and eyes are burning. But no pain anywhere else. Patient is very jittery and nervous. The patient tells you he was driving down the road and "just couldn't see the road anymore because it is so dark". He remembers hitting the ditch and just feeling the car "go wild". Patient denies any alcohol or drug usage. No medical history except for asthma. Has allergy to penicillin. Patient answers are very complete but sometimes weird. Pulse 130 BP 100/70 Resp 14 Pulse ox 98% on 15 L NRB. Monitor shows Sinus Tach. Trauma assessment is all normal. Pupils are equal and reactive but are very dilated. After you finish your vitals you see the patient start to fidget and talk about how stupid he is. He then repeatedly wipes his hands across his face as if he was trying to wake himself up. He starts getting more and more agitated as you prepare for transport. Then thrashes about and starts talking incoherently about death. What do you do? Link to comment Share on other sites More sharing options...
vs-eh? Posted July 16, 2006 Share Posted July 16, 2006 Do a blood glucose... He is lying about the drugs or alcohol... He is potentially in compensating shock...No skin or diaphoresis though? How much does this kid weigh and general appearance? Meth, Crack, Cocaine, E, whatever...Oh wait....GHB....It's GHB right? What do I win...I win reps... Whatever monitor his sorry ass and drive to le hospital... Link to comment Share on other sites More sharing options...
AZCEP Posted July 16, 2006 Share Posted July 16, 2006 Has to be some type of sympathomimetic, but his vitals don't jive. GHB is a CNS depressant, so it probably wouldn't present like this, but who knows what it was mixed with. Snow him, intubate, let the people with the sheepskins on the wall figure it out. Link to comment Share on other sites More sharing options...
Coach Hohman Posted July 16, 2006 Share Posted July 16, 2006 Correct me if I'm wrong, but if he were on cocaine, Meth, ext. wouldn't his BP be a lot higher than 100/70? Heroin might be a possibility, but him freaking out wouldn't necessarily coincide with heroin use, as heroin users are more mellow than anything. What about the use of acid? His hallucination could have led to the accident and would explain his head hurting, eyes burning, and possibly the slow pupil reaction. These are all kind of shots n the dark...Maybe he has a psychiatric disorder? You asked for a medical history, most people don't associate psychiatric histories with physical histories. Might be a good question to ask Link to comment Share on other sites More sharing options...
chbare Posted July 16, 2006 Share Posted July 16, 2006 Cidefex, does he take any medications? Any neurological deficits noted? Agree with the other posts on getting a BGL and trying to obtain more patient history if possible. (psych, seizures, diabetes, etc.) Try to calm him verbally if possible, however, we may need to consider restraining him if he starts to get violent. Are we able to administer medications? Try to reduce stimuli during transport and watch his ABC's. We will need to get a head CT without contrast and a tox screen when he gets to the ER. Take care, chbare. Link to comment Share on other sites More sharing options...
ptemt Posted July 16, 2006 Share Posted July 16, 2006 Is there more to tell us about the "trash and debris?" What is a 16 Y/O doing out at 2:00 AM if not partying? Link to comment Share on other sites More sharing options...
MrSpykes Posted July 17, 2006 Share Posted July 17, 2006 He is in decompensated shock, he is hypotensive or close to it, he is tachy, and has an altered mental status. Lets recheck vitals and do another trauma assessment. Its not heroine that would constrict his pupils and its not alcohol. Maybe cocaine. Could also be a head injury. Are the pupils PERRL. Restrain him and head lights and siren to the trauma center. monitor his ABC's, hang a bag TKO, constantly assess him on way in. Let the hospital know what you are bringing in. Link to comment Share on other sites More sharing options...
mediccjh Posted July 17, 2006 Share Posted July 17, 2006 Dilated pupils are a part of going into shock. Remember boys and girls, the B/P goes UP before it BOTTOMS out in shock. That would explain the tachycardia, along with the agitation and the feared FEELING OF IMPENDING DOOM (for the unintelligent, that would be the part about him talking about death). He is on the compensated/decompensated fence. He hit with enough force to take the windshield out, so it wouldn't be a surprise if he sprung a leak on the inside. Link to comment Share on other sites More sharing options...
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