chbare Posted July 26, 2006 Share Posted July 26, 2006 FL_Medic, can you clarify the airway? Unable to maintain the airway, but breathing is normal? If the airway is compromised, I would like to insert a NPA and start high flow oxygen. Lung sounds? If his breathing is shallow or very labored, we need to look at PPV. Lets put him on the monitor after taking the steps needed to maintain the airway and perform a rapid head to toe survey. Base line vital signs? In addition, get a BGL and have somebody spike a line. Can one of the first responders talk to the SO and obtain more history while we are working the patient? Allergies? Surgeries? Recent problems or complaints? Cannot find the meds? (Do we know what the meds are for?) Past medical problems? Take care, chbare. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 FL_Medic, can you clarify the airway? Unable to maintain the airway, but breathing is normal? If the airway is compromised, I would like to insert a NPA and start high flow oxygen. Lung sounds? If his breathing is shallow or very labored, we need to look at PPV. Lets put him on the monitor after taking the steps needed to maintain the airway and perform a rapid head to toe survey. Base line vital signs? In addition, get a BGL and have somebody spike a line. Can one of the first responders talk to the SO and obtain more history while we are working the patient? Allergies? Surgeries? Recent problems or complaints? Cannot find the meds? (Do we know what the meds are for?) Past medical problems? Take care, chbare. They are unable to hold their own airway open, but they are breathing ok with head-tilt chin lift. your NPA is in place and 15 lpm NR. Lungs cl VS - BP 110/82, HR- 156, SaO2 - 92%RA, 100% NR, BS - 70 Rapid survey you notice he is a little diaphoretic, a palor Allergies? unknown Surgeries? no Recent problems or complaints? CP from time to time, and spurts of ABD pain in the past couple months Cannot find the meds? (Do we know what the meds are for?) one is for the arrythmia, and she thinks the other is for stress Past medical problems?arrythmia unknown type Link to comment Share on other sites More sharing options...
vs-eh? Posted July 26, 2006 Share Posted July 26, 2006 Any mottling? Pupils? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 26, 2006 Share Posted July 26, 2006 any pill bottles lying around????? Let's do the basics, o2 15lpm nrb, npa or oral airway if tolerated Iv NS 12 lead Prep for intubation hospital 15 mins away so I'd not call the chopper Put the patient on a c-collar and board since unknown if he fell or what. I'd tube him if he tolerated the oral airway - protect the airway he certainly doesn't seem to be a good candidate for protecting it himself Get him in the ambulance, First responder driving, you and whoever else in back Drive 15 mins to the ER give radio report drop him off at the ER bed number 6 and that's it. Nothing really more to do. Link to comment Share on other sites More sharing options...
chbare Posted July 26, 2006 Share Posted July 26, 2006 Pale with a sat of 92% while on a NRB with NPA inserted, not good. PPV with cric pressure if tolerated. Compliance with PPV? Observe and palpate the abd. (Bowel sounds are worthless in this scenario.) Agree with the other interventions. Take care, chbare. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Any mottling? Pupils? Perl, no mottling Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 any pill bottles lying around????? Let's do the basics, o2 15lpm nrb, npa or oral airway if tolerated Iv NS 12 lead Prep for intubation hospital 15 mins away so I'd not call the chopper Put the patient on a c-collar and board since unknown if he fell or what. I'd tube him if he tolerated the oral airway - protect the airway he certainly doesn't seem to be a good candidate for protecting it himself Get him in the ambulance, First responder driving, you and whoever else in back Drive 15 mins to the ER give radio report drop him off at the ER bed number 6 and that's it. Nothing really more to do. Gag reflex intact there is more to do, you have done a rapid assessment, what about focused? What about the HR? Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Pale with a sat of 92% while on a NRB with NPA inserted, not good. PPV with cric pressure if tolerated. Compliance with PPV? Observe and palpate the abd. (Bowel sounds are worthless in this scenario.) Agree with the other interventions. Take care, chbare. Ahh, ABD distention is present. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Your meds have arrived: Digitalis and Prilosec Link to comment Share on other sites More sharing options...
chbare Posted July 26, 2006 Share Posted July 26, 2006 It looks like he has a problem that cannot be fixed on scene. Does the hospital have surgical capabilities? Start large bore lines with NS and blood tubing attached. I would be very cautious about fluid boluses however. Are there pedal pulses present? Difference between R and L blood pressure? Take care, chbare. Link to comment Share on other sites More sharing options...
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