Just Plain Ruff Posted April 11, 2007 Share Posted April 11, 2007 i'm leaning that this powder really doesn't have anything to do with the overall situation. I'm leaning towards a secondary drug ingestion. Link to comment Share on other sites More sharing options...
Eydawn Posted April 11, 2007 Share Posted April 11, 2007 Here's a shot in the dark... could they have OD'd on Ketamine? By any chance? It's an anesthetic abused by the "party club crowd", and can be snorted as a white powder. Something still seems rather funky about all this, however. I really want to know the AAOx? of our patients and how they're tracking per a full orientation questionnaire... Let's call them patients A B C and D, with A and B being our two that have *already* passed out on us. Orientation level of A? Orientation level of B? Orientation level of C? Orientation level of D? Can we get full 12 leads on all of them, both our pre- and post- blackout folks? Can we get the vitals from the charge nurse on the 2 non-conkers as a comparison? How about breath sounds and general physical appearance on all? I think a comparison between A, B and C, D might help with figuring this puzzle out... because two have conked and two have not. Unless C and D are lying and they didn't touch the powder. Which is something I want to know ASAP. Has anyone tried to convince these folks that it's a very possible life and death deal for all of them and that the repercussions are going to be the same whether they talk or not, and that talking might just mean they make it to tomorrow? And hey, do we have parental consent for treatment on all these guys? Contact with parents RE medical histories? Where did they meet the mystery powder man? What were they doing? How long ago did they inhale, ingest, or otherwise introduce the mystery powder into their systems? Any evidence of powder in their nares? Wendy CO EMT-B MI EMT-B Link to comment Share on other sites More sharing options...
hammerpcp Posted April 11, 2007 Share Posted April 11, 2007 I'm back. So apparently this girl has a canine bleeding disorder. That's your first problem right there. She's the wrong species! Quick someone call a mediVet STAT! Did the RN administer anything to this pt? Dextrose for example? Oxygen or assisted ventilations? Link to comment Share on other sites More sharing options...
hammerpcp Posted April 11, 2007 Share Posted April 11, 2007 I really want to know the AAOx? of our patients and how they're tracking per a full orientation questionnaire... Wendy, Since you have freakishly large frontal lobes could you please explain this (above) to me/us? What exactly is a "full orientation questionnaire"? Link to comment Share on other sites More sharing options...
Asysin2leads Posted April 11, 2007 Share Posted April 11, 2007 I say cheat. Supportive care and bring 'em into the hospital. Let toxicology sort out the powder if they really care. Otherwise smack 'em around a little and send them on their merry way. Link to comment Share on other sites More sharing options...
Eydawn Posted April 11, 2007 Share Posted April 11, 2007 Hammer, I guess I was still in creative writing mode... "Full orientation questionnaire" for me refers to every possible question I can think of to assess the orientation of these kids. The standard battery of questions you ask and then some, like who's the president/governor, how many quarters in $1.50, where are you, who are you with, why are you here, what were you doing before you got here, what time is it, what city/province/state are we in, where is the capital located, how many feet does a dog have, what color is this thingy over here, how many fingers am I holding up, what's your doctor's name.... most people can get the obvious ones even in a drunken/altered state I've found, so I just get creative and ask things they'd be expected to know and can't necessarily look around to figure out the answer to. I like to pepper the questions in there as I'm asking other assessment questions. If nothing else sometimes it makes folks laugh, and it certainly gives a much better picture of how awake, alert and oriented folks really are. For example... I could answer the standard ones in my sleep because I've asked them so many times. Doesn't mean I'm oriented. It isn't anything official.. just my way of phrasing that and I do apologize for any confusion.. Wendy CO EMT-B MI EMT-B EDIT: Do I really have freakishly large frontal lobes? I don't intend to come off that way.... Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 11, 2007 Share Posted April 11, 2007 I think all of us on this thread should split the powder no wait never mind someone still needs to dip their pinky in it and test it out. What can it hurt??? Link to comment Share on other sites More sharing options...
Acosell Posted April 11, 2007 Author Share Posted April 11, 2007 The other two both had a period of decreased LOC as well, but not exactly a drop of 12 on the GCS. They are recovering and the nursing station does not feel the need to transport them at this time. The nursing station has very basic capabilities. Think of it as a walk in clinic with gurneys and no doctors. Their resources are stretched thin, but they will be able to manage the remaining two patients. The remaining kids are 13 and 14 years old, there are numerous parents and locals meandering through the hallways. None of them know anything about what the kids took, and nonbody can get the kids talking. As for dipping your finger in the mysterious substance, the reason you promptly placed it in a biohazard bag is because the baggie the nurse handed you was torn and spilling mysterioud white powder all over you. You start to take 12 leads on all 4 of the patients, but run out of electrodes after the first couple. Nothing appears unusual on the ECGs. Lungs are clear. You instruct your patient to take deep breaths during your assessment, and note that she has difficulty inhaling deeply. Her regular breathing pattern appears unaffected. Generally they all appear pink warm and dry, they are all under large heaps of blankets, all conscious but drifting in and out of sleep. The only information about what they took you've been able to get is that your patient snorted a "loonie sized pile", and everybody else had less then her. You threaten death, but nobody seems to mind. You consider the fact that this community and others nearby have some of the highest suicide rates per capita in the world. The patients mother ensures you that her only history is Von Wildebrand disease. Nobody is talking about where they met the mystery powder boys. They presented in the nursing station at about 9pm the night before complaining of light headedness and nausea. There is no evidence of powder in the nares. I have actually met a lovely doberman with vWD, but I assure you it affects humans as well. Perhaps if I had spelled it right... "Von Willebrand" http://en.wikipedia.org/wiki/Von_Willebrand_disease When the patient went unconscious, the nursing station administered one dose each of Narcan and Flumazenil. The patients evidently responded, but they claim it didn't appear to be because of the administration of those drugs. No 02, no assisted ventilations. You ask as many questions of the patient as you can think of, including how much wood a woodchuck could chuck, etc. She ignores you, briefly making eye contact, then looking away. Anyhow... You place the patient on your #9 stretcher, load them into the back of a pickup truck along with all of your gear, and head to the airport. Upon arriving at the airport, you begin a maintenance infusion of 85 ml/h through your IV pump. The pilots do their thing and you all take off towards the receiving facility. Enroute your partner attempts to patch with the sat phone, but accidentally calls a tim hortons over 1000km away. You note no changes during the flight. Your patient and her mother both sleep during the entire trip. You land at the airport and the local land crew meets you to take you and your patient into the hospital. It's now 7am. During your brief transport into the hospital the patients respirations decrease. She appears to be sleeping, but you want to make sure. You wake her. She acknowledges you and rolls right back over. You arrive at the sending facility and transfer care. You pass off the bag of white powder. The janitor at the facility grabs the bag and dips his pinky into the powder and tastes it. "Well it ain't coke" he says, disappointed. "So what is it then?" You ask. He doesn't know. So what was it guys? Link to comment Share on other sites More sharing options...
becksdad Posted April 11, 2007 Share Posted April 11, 2007 How about bootleg Dextromethorphan? I understand it is sometimes sold via internet sites, referred to as DXM, in powder form. Some kids experiment with it as a supposed hallucinagen in megadoses. In large doses it acts as a dissociative anesthetic. Also, many forms of Dextromethorphan, both OTC and bootleg are combined with other active ingredients such as decongestants and/or antihistamines. There have been several fatalities through the idiotic use of this drug, including a double fatality in my neighborhood last year. Link to comment Share on other sites More sharing options...
Urbanmedic461 Posted April 11, 2007 Share Posted April 11, 2007 How about bootleg Dextromethorphan? I understand it is sometimes sold via internet sites, referred to as DXM, in powder form. Some kids experiment with it as a supposed hallucinagen in megadoses. In large doses it acts as a dissociative anesthetic. Also, many forms of Dextromethorphan, both OTC and bootleg are combined with other active ingredients such as decongestants and/or antihistamines. There have been several fatalities through the idiotic use of this drug, including a double fatality in my neighborhood last year. Sounds like you worked in James Bay too Link to comment Share on other sites More sharing options...
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