You look so good in mauve....

[JPINFV]

^

Said firemen weren't really mentioned in the original post. But that's really neither here nor there now anyways.

[MeekoBB]

JP hampcp said it in the 2nd update iwth the patient int he first paragraph that the partner returned with the hosemonkeys

[fiznat]

I havn't found that the color of the MDI body correlates very well to the medicine inside, as the bodies are reusable while the medication itself is obviously not.. In any case, a google image search found this so maybe it'll help:

It looked like the website it was from was written in spanish so perhaps that changes things...

[JPINFV]

JP hampcp said it in the 2nd update iwth the patient int he first paragraph that the partner returned with the hosemonkeys

Which is right after my first post....

[Richard B the EMT]

Took me a while, but re the search for grape soda cans: If the patient spilled grape soda on himself, just might be the reason for the patient's purple color. HOWEVER, don't count on it.

[spenac]

Took me a while, but re the search for grape soda cans: If the patient spilled grape soda on himself, just might be the reason for the patient's purple color. HOWEVER, don't count on it.

I mentioned grape soda for as what you mentioned and also because being that fat probably has diabetes and may have overdosed on sugar, whether because of grape soda or other product. I have also seen a patient that had a very orange color tone turned out guy basically lived on cheap orange soda. Dyed himself orange from inside out.

[Richard B the EMT]

Hmmm, true, too on both counts.

[hammerpcp]

Okay.....So number one who cares who said what when.....there are fire monkeys on scene to assist you. Number two, the purple/blue colour to this guy is central cyanosis not purple soda induced..........although thats funny. Number three, FYI beached whales die because they cant breath...but whales breath air so WTF right? They do literally crush themselves to death. Their diaphragm can't descend and there thorax can not expand.

Fourthly (if that is a word) it has occurred to me that this post may have been better placed in the scenario section of the forum, and I am frankly disappointed that no one has come out of the woodwork self righteously "screaming" such. Tsk Tsk you guys are losing it. Haha.

Some one wrote that "you will eventually have to tube this guy". And I though :AHA! there in lies the real question.

Now back to our regularly scheduled program.

OKay so you've sat the Pt up with the assistance of two of the firemonkeys and propped him up with clothes/pillows lying around the room and you are bagging him via BVM. Within the first minute his colour improves quite dramatically although he still quite a ways from human looking. He has some saliva coming out of his mouth.

He has also become slightly more rousable. When you manually open his eyes he seems to have a purposeful gaze and he makes some incomprehensible sounds when you provide loud verbal stimuli in is ear.

At this point you don't think your pt will take an OPA but your partner is on it and is inserting a NPA. Result: R nostril you meet resistance. L nostril goes in fairly smoothly until the end when your pt has a gag reflex and a minor epistaxis. (oops)

No more History for you, sorry. But bro knows there are no allergies.

As requested:

Full set of vital signs: HR 120 sinus tachycardia. SpO2 88% with BVM and modified jaw thrust. RR spontaneous @ 30 (bagged slightly slower). BP 110/80

-Lung sounds: You can't hear shit.

-Blood sugar: 7.8 mmol/l (slightly above average values, but probably normal for this guy)

-ETCO2 would be nice to really evaluate that breathing/perfusion/etc: We don't have the capacity to measure this but I can tell you he is hypercarbic through the roof.

-Neuro checks (pupils, reactivity to painful stimuli, babinski, etc):pupils are reactive and equal, he seems to be moving all extremities.....I'm not giong to do a babinski reflex check until someone can explain to me what extrapyramidal really means. Sorry.

-Physical exam. Is the purple color cyanosis: yes. Purple is cyanosis.

Okay so the fire monkeys are feeling extremely manly after the bbq they had for breakfast and opt out of calling for more assistance. The six of you should be able to do it. You already have a fat mat/tarp (which rips BTW :shock: but is still usable).

Now, my question for you all is what is your next treatment decision? You know you are going to have to stop bagging this pt at effectually for up to five minutes as you extricated him form the residence. Are you thinking of any pharmacotherapies? Intubation?

Someone mentioned something that needs addressing because I can't stand misinformation. You can't overdose on sugar. If you aren't physiologically normal then you can become hyperglycemic but thats different. Maybe it's just semantics but I had to say something.

[hammerpcp]

[fiznat]

I think you are confusing the pyramidal tract with extrapyramidal response. The first is one of the areas in which the babinski (plantar reflex) test checks for damage. It is a structure of upper motor neurons that I honestly know very little about, although I do know that positive babinski tests suggest neuro tissue damage that often coincides with a very poor prognosis. The extrapyramidal response, named so specifically to distinguish it as seperate from the pyramidal tract, refers to a neurological response arising outside of the pyramidal tract. Wikipedia tells me that this means the effector motor neurons are stimulated though indirect means in contrast to the pyramidal tract's more direct method. In any case, we often use the term "extrapyramidal response" to describe a common side effect of anti-psychotic drugs like Haldol. I'm sure you've seen it before: facial muscle rigidity, lip smacking, etc... treated with benadryl.

I asked about babinksi only because I routinely do this on unresponsive patients in order to help evaluate neurological damage. It sounds like this patient would have been negative anyways.

ETCO2 would do more than tell you hyper or hypocapenic, but if it is not available it is not available.

Given what you've told us, I dont think I would want to intubate this guy until we get him extricated. It sounds like it is going to be a pretty rough ride out of the house on the tarp, and to be honest I wouldn't expect a tube to survive the trip. If it is going to take a while, I would instead plan to have a few regular pit-stops where the patient can be bagged, and then continued out of the house. Consider intubation afterwards, maybe.

Does this patient have an in-home bipap machine or something similar? At that size, I wouldn't be surprised. I wonder if throwing that on, or perhaps your own cpap if you have it, would help.

So how'd the extrication go?