EmergencyMedicalTigger Posted April 3, 2007 Share Posted April 3, 2007 What?? no d-sticks? Ok...can you or have you requested ALS? How far away is the hospital? Link to comment Share on other sites More sharing options...
JCicco345 Posted April 3, 2007 Author Share Posted April 3, 2007 ALS requested with a 3 minute ETA, the hospital is about 4 or so minutes away. Also one of the FFs says hes run across this indivudual before and hes a known herion addict. Link to comment Share on other sites More sharing options...
EmergencyMedicalTigger Posted April 3, 2007 Share Posted April 3, 2007 Ok...so once ALS is on scene, can I get a d-stick now? What do his pupils look like? How are his vitals? Link to comment Share on other sites More sharing options...
becksdad Posted April 3, 2007 Share Posted April 3, 2007 Ok, ALS is 3 minutes out, hospital is 4 minutes away. Resps are 24, sustained heart rate at 140. 100% O2 in place - good. You think bed is covered in bloody feces (it's a very distinctive smell, dried or not). Patient drinking alcohol, known heroin addict. Not worried about heroin OD, his resps would be very slow to non-existent. So I'm back to G.I. bleed. I'm betting B.P. is low - get him supine - maybe strapped to backboard, get him downstairs on the board. I wouldn't waste any more time assessing or trying to treat anything on scene. You could be at the hospital within 60 seconds of ALS arrival on scene, so why wait? It would be an additional 4 minutes to get him to the hospital by waiting for ALS. If Fire has a Medic on scene, snag him to provide ALS care enroute to hospital (I.V., fluid bolus, 12 lead, even Narcan although that seems to be the least of this patients problems, etc., etc., etc.). Do any further assessments enroute. Be prepared for vomiting and ventilation assistance. In general, treat for shock, supportive care. Based on the info provided so far, the sooner this patient gets to definitive care the better. I don't see any advantage to waiting or continuing assessments that do not address ABC's. Whatever you can get in the way of further history or assessment info, fine, but get going. From what I see so far, that's how I would have run the call. Link to comment Share on other sites More sharing options...
JCicco345 Posted April 4, 2007 Author Share Posted April 4, 2007 D-stick = 164 HR = 140 strong and regular Pupils = smaller than normal but not pinpoint Resps = 24 B/p = 110/p Link to comment Share on other sites More sharing options...
JCicco345 Posted April 4, 2007 Author Share Posted April 4, 2007 Becksdad, I like where you went with this, I'm in full agreement with the get out and to the hospital as quick as you can. That's pretty much how the call went for us. By the time we had stairchaired the patient out to the ambulance, we started transport and got ALS at the end of the street. He was a tough stick, so he got 2 of narcan IM and the EKG, then eventually got a line before we got to the ED. He was still non-verbal, and had no response to the narcan. We went out on another call, but by the time we got back to the ED, maybe 30 minutes, he was intubated and they were waiting on an ICU bed. Turns out he did have a GI bleed, also a PH of 7.14, a little acidosis. Link to comment Share on other sites More sharing options...
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