Acosell Posted April 10, 2007 Share Posted April 10, 2007 You are sleeping blissfully after staying up late to try to get your computer working. Out of the dark comes a knocking on the door. "We have a trip!" the first officer shouts. "Okay!" you reply as you roll out of bed. You don your flight suit, and carpool to the airport. You meet your partner at the airport, and as soon as he sees you he asks "Do you know what's going on?" "Not a clue" you reply. "I don't even know where we're going." "Me either" your partner grins. "You go check the plane, and I'll call dispatch for an update". You proceed to the hangar and run your checklists, sign out the narcs, and put your bags on the aircraft. You return to the co-ordination room and overhear your partner talking to dispatch on the phone. "Really?... wow.... alright.... how much? and when was that? how many of them? Oh boy.... Okay... Thanks, you too" he hangs up and smiles at you. "What's up?" you ask. "13 year old female took some unknown white powder, and now she's unconscious. Looks like the nursing station gave her 0.4mg narcan, and some flumazenil as well, but no effect. Vitals are pulse 110, respirations 26, 125/84, pupils 6 and sluggish, GCS 3, satting 96, sugar 2.1mmol/L" You let a long "hmmmm" out as you think about the situation. "That's not all" your partner continues. "There's 4 patients, all took the powder. Ours is the only one unconscious, but nobody's talking" You nod as you board the aircraft. Once you're airborne, your partner calls dispatch on the satphone for an update, but there is no additional information available. At 5:02am you land, and a local picks you, your partner, your monitor, your drug bag, your airway bag, your IV pump, and your vent up and takes you into the nursing station. You walk in the door and a nurse directs you to your patient. Your partner leaves you to assess the patient as he takes a report from the head nurse. The first thing you notice is that your patient isn't acctually unconscious at all. You recall that the report you got is an hour and a half old, and so are the vitals. All the same, you do your assessment. What specific assessments would you like to start with? Link to comment Share on other sites More sharing options...
AnthonyM83 Posted April 10, 2007 Share Posted April 10, 2007 I'm just an EMTB, but to kick it off, how about: -General Impression -BP/Pulse/Resp/Pupils/Skin -O2 Sat/Monitor -Neurological assessment: Level of conciousness/Circ-Motor-Sensory/Behaving Normal? -SAMPLE (what will she tell you about the event?) -Any chief complaint? -Confer with parents/nurses/other kids..have they learned anything new and has anything more been done medically for her since your last dispatch update? Do they have intermediate VS since the first ones you got, but before now? How did she come around? Link to comment Share on other sites More sharing options...
Niftymedi911 Posted April 10, 2007 Share Posted April 10, 2007 Would it be too far fetched to go into HazMat situations?I would my assessments accordingly like as previouisly stated only adding the following : Airway Management Definately a repeat blood sugar Law Enforcement invovlement ( if not for suicide reasons, but an attempt to scare the kids into talking). ETCO2 Cardiac Monitor Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 10, 2007 Share Posted April 10, 2007 I read something that stands out - what do you mean "Isn't unconscious now" What's her LOC now??? I think this is the most important thing not withstanding ABC's With that said: Is this patient intubated? With a Glasgow of 3 I would expect that they intubated her already. HMMMM what's goin on with this patient. Are there any signs of a pesticide response - such as Organophosphates? Have they been able to do a drug screen on this bright star of the teenage world? Start with the basics ABC's - Vitals again please repeat the d-stick What about IV's? Any? Cardiac monitor After the hour and a half flight - have the other einsteins made any statements to lead you one way or another? Link to comment Share on other sites More sharing options...
Acosell Posted April 10, 2007 Author Share Posted April 10, 2007 You walk into the exam room and listen to the nurses report. She tells you that since they called for a medevac, your patient regained consciousness, and another of the 4 lost and regained consciousness. They haven't rendered any additional treatment other then that outlined in your initial report. New vitals are as follows: P: 100 R: 20 BP:124/65 GCS:15 Sp02: 98 Pupils: Right - 4 and reactive Left - 4 and sluggish CBG: 5.8mmol/L No allergies No medications History of Von Wildebrands disease The nurse tells you that the girls were hanging out with some older guys who had the white powder. They told the girls not to snort it, but they did anyway. At this point the nurse hands you a ziplock baggie with a small amount of powder in the bottom which you promptly place in a biohazard bag. She continues, telling you that initially when the patient went unconscious her resps briefly dropped to 8 breaths per minute. The nurse has started a 20g IV in the patients left forearm, running TKVO. Hazmat is not available in this community, and Law enforcement originally brought the patients in and have since washed their hands of the incident. Your patient is awake, but refuses to talk to you. She appears very tired, but co-operative. Cardiac monitor shows Normal sinus at 99, and still, nobody is talking, but at least you have the mystery substance now. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 10, 2007 Share Posted April 10, 2007 Ok, does this patient require air ambulance transfer to the receiving facility? Could she go by ambulance? Does she or one of the other bright stars require any type of air ambulance transport? Her vitals sound ok Can we get law enforcement back with their drug test kit to test what this substance(illegal substance) is? What did the hospital drug screen show? Have they done any lab work? cbc, chem22, drug screen, pregnancy test. Urinalysis What are the resources if you have these kids go by ambulance to the facility that the one you were called for was supposed to go to. has the hospital seen any other kids or patients with this type of substance that they could tell you about? It would provide a little better picture of the ingestion. Granted these kids need to be observed but do they need air ambulance transport? Link to comment Share on other sites More sharing options...
AnthonyM83 Posted April 10, 2007 Share Posted April 10, 2007 So, what's a short acting drug that is found in a white powder form that knocks you completely out for a bit? Are the patients completely alert and oriented or are there any residual effects, like wooziness or possible hallucinations or visual problems or headache? Date rape type drugs come to mind, but I from what I've heard there's usually residual effects. It doesn't just stop acting. Narcan didn't work, right? So, it's not an opiate... Link to comment Share on other sites More sharing options...
Acosell Posted April 11, 2007 Author Share Posted April 11, 2007 The patient requires air ambulance transport because there is no road access to the community. Law enforncement is limited and does not have that capability. This is an extremely remote location. The nursing station does not have the facilities to do drug screens, labs, or much else. Again, this is a very remote location. The nursing station has already organized another air ambulance for the second most acute patient. By their judgement, the remaining two do not require medevac. The nursing station has no previous exposure to the powder, this appears to be an isolated incident. The nursing station is very basic in it's ability to provide care, and as a result the two patients will be flown out. Keep in mind that perhaps the drug didn't come in powder form. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 11, 2007 Share Posted April 11, 2007 Well this may be a short acting barbiturate We now have the info that one other has gone unconscious and then regained I would urge the nursing staff to expect the other two to follow in their valedictorian and salutatorian's footsteps and go unconscious and then come out of it. What type hospital is this you are at? What actually can they handle? Can they handle 4 patients that present this way? How many beds are in the hospital and what level of skill and resources do they have to take care of these 4 patients. It sounds like a short limiting problem that resolves itself but there is no way to know what the additional extent of their conditions will be. I'm waiting for some more info on this. How old are the other kids? Are their parents there? Can their parents get anything else out of them? Link to comment Share on other sites More sharing options...
hammerpcp Posted April 11, 2007 Share Posted April 11, 2007 Clearly for the greater good you need to dip your pinky in and sample this mysterious substance. WTF is von wilderbeast disease? Google here I come. Link to comment Share on other sites More sharing options...
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