Dispatched to assault. Really?!

[Shrimpfriedrice]

In these sort of cases I would ask for a good neuro exam. And what was her GCS?

Gcs :10

 

[Handsome Robb]

Gcs :10

Can you break it down for us, please? Lots of combinations can reach a total of 10.

 

[Shrimpfriedrice]

In these sort of cases I would ask for a good neuro exam. And what was her GCS?

Gcs :10

Without signs of hypoxia or respiratory distress you don't give high flow o2, that's for sure. Were there any indications in the physical exam that she was hypoxic/hypoxemic? From what you described it doesn't sound like it. If CVA is high on your list of differentials high flow isn't a very good choice. Hyperoxygenation can cause more harm than good in these patients. There's a reason low flow o2 is the standard for CVA care. The whole "just load the blood up with o2 so there's a chance more o2 will slip past the clot" idea doesn't hold any water.

Not trying to be an *** but in the future you'll get better responses to your scenarios with more detailed information and better structure to them.

I'm having a hard time understanding why it was so difficult to get a BP on this patient... her being a "little person" isn't a good reason. Hypotensive then sure that makes sense, not hypertensive though.

If i gave a bp right away it would defeat the purpose. And isnt hyperventilation indicated in rising icp? Not that it was done here. And i never said we couldnt get a bp because she was a little person i was simply building the senario. And its not just me if both emts, medics and hospital staff have trouble have trouble getting a bp.

And as i said before without all that info given to u nicely how can i make a cva call ruling out other things o2 would be indicated for?

 

[Handsome Robb]

Your grammar is really difficult to understand, bud.

I'm not asking to be spoon-fed.

Vitals are generally part of the initial assessment, so generally they're presented in the beginning of the scenario...

Hyperventilation is different from hyperoxygenation. Increased ventilatory rate does not equal increased FiO2. There's lots of arguments about hyperventilation in patients with suspected increased ICP. Usually it's something you want to be doing with a definitive airway and ETCO2 monitoring to titrate to a desired ETCO2, generally ~30mmHg.

 

[RustyShackleford]

Your sentence structure is so god awful, it is difficult to follow what you're saying. If it takes a paramedic on scene to get a bp, god help you.

 

[NomadicMedic]

The CLs are now paying close attention to this thread.

Everyone take a deep breath before you post.

 

[FLdoc2011]

Gcs :10

Was a full neuro exam done?

What all was done prehospital?

And throwing high flow O2 on is not hyperventilating.

 

[epipusher]

Easy. Eyes open and no one is home. Not uncommon in absence seizures, or the postictal phase.

a doa may have their eyes open. so awake yet unresponsive?

 

[NomadicMedic]

a doa may have their eyes open. so awake yet unresponsive?

No matter how you slice it, awake does NOT equal "dead with eyes open"

 

[JPINFV]

"Spontaneously opens eyes" and "eyes are open... but not moving" are not the same thing.

 

[Melclin]

Its easy to say why is she on o2 with all the info placed nicely right before you. Now ask yourself someone presents as ams, u have no history, non verbal, no glucometer or pulse oximeter bls. What do u do?

I agree with you in the absence of reliable pulse oximetry. However, you posted an SpO2 when mentioning the O2...So you must have had oximetry. Maybe you didn't originally have oximetry and a second responder brought it. We were not to know this, which is part of the reason why reasonably detailed information in the OP is important.

To expand on the clinical side of this issue, it is not obvious why O2 would be applied despite an adequate SpO2, altered conscious state or not. I would argue that the application of O2 in situations where any serious illness may be 'possible' is no longer the standard of care in the absence of documented hypoxaemia or other reason for supplemental O2. This may be a learning opportunity for you in that the standard of care might differ from your original education and/or protocols. I assume the whole reason you came to a forum like this was to expand your knowledge beyond a protocol book.

Have I misunderstood something?

If i gave a bp right away it would defeat the purpose. And isnt hyperventilation indicated in rising icp? Not that it was done here. And i never said we couldnt get a bp because she was a little person i was simply building the senario. And its not just me if both emts, medics and hospital staff have trouble have trouble getting a bp.

And as i said before without all that info given to u nicely how can i make a cva call ruling out other things o2 would be indicated for?

I understand that it is difficult to present a scenario in writing while trying to capture the difficulty of a stressful situation and prioritising assessments and treatments. However, simply saying, "person with x"...go, doesn't work too well in my experience. Given a scenario like this, it is reasonable to assume that people will be asking for the results of at least a rough primary survey, vitals, an assessment of conscious state, pulse oximetry, monitoring, BGL, some kind of secondary survey or physical exam as well as a focussed neuro exam of some sort and further info about the event and her medical hx. Few providers would omit these things.

A set of vitals is not a mystery. Its not like someone will cleverly ask for a BP, it then reveals the nature of the illness and everyone thinks, "Oh gee, I wish I'd thought to take a BP". There are certain investigations that can be reasonably assumed given that we are to some extent all on the same page as far as basic pt assessment goes. I might suggest that this information be provided in the original presentation in future.

 

[Handsome Robb]

A set of vitals is not a mystery. Its not like someone will cleverly ask for a BP, it then reveals the nature of the illness and everyone thinks, "Oh gee, I wish I'd thought to take a BP". There are certain investigations that can be reasonably assumed given that we are to some extent all on the same page as far as basic pt assessment goes. I might suggest that this information be provided in the original presentation in future.

Well put.