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"She doesn't look right"


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Well, lets tackle at least one of the problems. Start a saline IV to address the lithium OD.

As for the other pills, double check for OTC's, especially NSAIDs which can increase lithium toxicity. It's a funny drug with chronic users being more susceptible to OD that one-time users.

If the OD is serious enough, hemodialysis will be required. Stick in the saline IV and go as effects of OD can be delayed from ingestion. Get extra hx (as above) enroute.

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Ibuprofen emerges as another med.. how about that! Ok, IV initiated, patient is pretty cooperative, just really spacy. Resps, vitals, all still the same. Pt. was treated with normal saline in the ED, don't know what else they did with her. Came back that night really pissed off and got in my face because somehow everyone knew what happened... (Don't look at me, look at her coworkers... I don't break HIPPA).

Would you consider advising anyone to transport this patient POV, by any chance? (That's what the camp nurse decided to do- sent her out in a car with the nearest hospital 45 minutes + away).

Pretty simple scenario..

Wendy

NREMT-B

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No to the POV. Too far for my taste. If pt. went downhill, I'd want my hands free and access to a radio for ALS intercept if it really went sour. In our locale, paramedics (we don't have EMTs) can start IV's as a standing order. Not clear by your post whether an IV was started at camp (and running what). You did say saline at the ED though. Seems to have done the trick.

nice scenario. gtg study though..A&P !

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No, no IV started at camp... the nurse (terrible nurse) decided to send her out POV... I wanted to send her BLS, but nope, I lose... since the nurse is my boss... fortunately she didn't go downhill and made it in to the ED ok.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

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Sounds like your camp nurse needs a kick in the pants. I cant think of a time off hand where i would consider a pt with the s and sx that you are describing being transported pov. What would your nurse have done if the patient had crumped and what would have been her liability issues?

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Don't know, because none of the medical staff accompanied this individual to the ED. The nurse sent one of the over 21 staff as a driver and that was it. I think b/c the patient was oriented X4 and could answer appropriately, if delayed, then her consent to go POV with our POV release form removed liability from the camp. However, this form is very similar to an AMA... but that was the advice given "let's get her out POV, find a driver". Dunno what the lawyers would have done with that one!

Wendy

NREMT-B

CO EMT-B

MI EMT-B

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