ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 Describe Scene (any possible MOI~~step ladders? where in room was she and what was she around) ABC's and BGL already obtained above ! Carotid pulses are present = & ll ? hx of allergies? ask son? possible recent conflicts with others? last oral intake ( if possible to know)meds or meals...Any recent changes in HTN meds? Pupils are? GSC? arriving on scene--#1 never ASSume a scene is safe. RTA while obtaining SAMPLE. With what I have to go on now- C-spine, package, (Load and go) Naturally depends on if she just passed out or possibly fell into or on something. On truck- suction airway and apply OPA w/ NRB of tolerated/if not then NPA w/^ O2 @ lpm depending on spo2 and possible CO2 level if obtainable. NS & LR IV "18g" @ tko....More info to decide transport method....Begin ALS assessment. neuro exam, assist medic with 12 ld. etc Give more info please!!! We should do more of these Scene is a 1 story house. She is in the hallway as previously described. There are no ladders, stairs or stepstools. Carotid pulses are present. Not sure what you mean by II (I'll defer to Dust for points deduction). Son says she has no allergies. No recent med changes. Son said she was eating breakfast when he left this morning. The son thinks she has been feeling down lately but nothing serious. Pupils are dilated to 8mm and minimally reactive. You can assume the scene is safe because I told you it was. Nothing tricky here. Not sure what RTA means (Dust?) Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 ERdoc- Does this patient have tachy brady syndrome? Because it sounds just like a call I did recently. If so.. she needs a pacemaker! Nope. Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 Ok lets see, Pt is rapid transport request ALS C-spine protection any other patients? A) gurgling respirations - reposition airway with jaw thrust since we can't rule out trauma suction prn 8/min tolerates NPA gag reflex if the patient is pink and people are limited my questions are: will the NPA allow us to use a nrb or does my partner who is maintaining spinal precautions having to jaw thrust her still. If shallow resps BVM @ 10/ min Question lung sounds C) skin color temp and moisture Iv lock as noted above base line V/S Monitor 12 lead BGL is fine Seems no finding for RTA Seems Initial GCS of 10 Secondary survey: Review ABC changes and monitor therapies head to toe palpation inspection auscultation, meds allergies any odors in the house any other feeling ill? No other pts. Lung sounds are rhonchorus diffusely. Skin is very warm to touch with dry skin, color is normal. No one else is feeling ill and there are no odors. Head to toe reveals no deformities, bruising, rashes. RTA? Are people thinking Renal Tubular Acidosis based on what we have so far? Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 what is her h&h trendelenberg :twisted: :twisted: :twisted: Your aggressive service allows you to do H&Hs. Hers is 14.5 and 44.2 Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 I want to find her meds. Are we seeing empty pill bottles anywhere? Bedside, trash cans, bathroom? Big pitcher of water that is out of place? I'd like to see that EKG. Are her lungs good? What about her temp? Sp0[sub:880df1a302]2[/sub:880df1a302]? With our assumption of a safe scene, then I guess CO poisoning is out of the realm of possibilities. Without signs of trauma, and assuming her oxygenation is okay, I am happy with an NPA for airway at this point. And assuming the EKG and lung sounds are unremarkable, I'm going with a fluid challenge on the way to the hospital. The son is not sure where she has her pills, but he will look for them. We don't see any so far. Temp is 101.8 (yup this was rectal). It is safe to assume that this is not CO, but if you want we will have the FD check and they will confirm that this is not the case. Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 What is her "normal" blood glucose level? 132 mg/dL could very well be hypoglycemic for this patient. ECG? Pupillary response? She seems to be protecting her airway adequately for now. Move to the transport unit. The son tells you that she keeps her sugar under good control because she does not like the way she feels when it is high. Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 I'm with dust, what medication bottles can you find and what are the numbers of pills in each bottle? This could be a combination reaction the a pharmacopea of medications. Did we check pupils? Does she feel hot? But Seriously doc, this isn't pufferfish poisoning again is it? Waht are her vitals pulse, bp rr we know the sugar 12 lead or cardiac monitor What time of year is this scenario goin on at? How long has the son been in the house and is he exhibiting any symptoms of CO? How bout the EMS Crew? If she's unconscious with unknown etiology I'd suspect 1. Diabetes 2. cardiac 3. CVA 4. infection 5. environmental(CO?) The son does not beleive she has ever eaten Fugu and then questions your competence. This is happening in the spring and it has been nice (no need for heat). Link to comment Share on other sites More sharing options...
ERDoc Posted July 11, 2007 Author Share Posted July 11, 2007 You said gurgling respirations...is the airway clear, any fluid, if so what? Definitely interested in the meds (look at quantity of pills and compare to date issued as well as rate to be taken, try to determine if OD is a possibility). Make sure the pt is in the sniffing position. Any difference in pain response between left and right sides? Last time she was "normal" was when the son last saw her? How long ago? May not be much but it's something. Any ETOH around? Smell anything on her? There are no alcohol bottles laying around. She does not smell like she has been drinking. The son tells you she does not drink. Here is your 12-lead. Link to comment Share on other sites More sharing options...
Sdowler Posted July 11, 2007 Share Posted July 11, 2007 OK RTA = Rapid Trauma Assessment The H&H thing was just a joke for someone else on the forum disregard it If her GCS is so low how does she have a gag relex or am i picking nits Link to comment Share on other sites More sharing options...
chbare Posted July 11, 2007 Share Posted July 11, 2007 Hmmm..I have not seen this in a while. Look at her history and presentation, then the 12 lead. I think the puzzle should come together quite nicely. Unfortunately, the problems is not very nice. Take care, chbare. Link to comment Share on other sites More sharing options...
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