BlueJayMedic
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Call comes in CTAS3/Code2 for a syncopal episode not seizing, now alert. 0840hrs.
46 y/o female found supine at cottage covered in a towel. Pt states she was going back and forth between the hot tub and cold shower to boost her immune system when she felt weak suddenly and boyfriend lowered her to the floor where she laid unconscious for 2+ minutes. Pt is emotionally upset (more than to be expected), and appears to be anxious and has a Hx of the same. Pt released from local psych unit after an 8 day stay for manic depressive episodes. Pt states for last 4 days at hospital she had a headache which was not treated by staff. No cardiac or neuro history. Pt takes daily anti-depressant (can't remember name, not TCA) as only medication, no allergies, last meal was the previous night.
Initial vitals while supine:
A/O x 3, BP 160/90, HR 112 NSR, RR 18 R/F, SPO2 98% on RA, BGL 5.6mmol/L
12-lead non-diagnostic, sinus tach, unremarkable.
Patient adamantly refusing to go to hospital and being extremely dramatic throughout call. Family arrives and finally pt is talked into transport. In a fit gets up and agrees to go to hospital with EMS (as my partner is preparing the sign off paperwork) and storms out of the house on her own accord. Pt lays semi-sitting on stretcher, vitals are unchanged.
We depart scene and get about 3 house lengths down the road when the pt becomes unresponsive.
Vitals: GCS-3, BP 130/70, HR 48, RR 8 Regular and clear with airway positioning, Patient accepts OPA, no gag reflex. SPO2 98% on RA
Monitor shows sinus brad, 12 lead confirms sinus brad, otherwise unremarkable.
OPA is inserted and ventilations assisted with BVM, priority upgraded, FD requested to meet up en route (volunteer agency). FD arrives and is loaded into the back. 2 minutes later (12 minutes unresponsive at this point), Pt sits up on stretcher, pulls out the OPA with a large gag and starts swearing and yelling. Pt is now GCS-15 alert to person, place and time and is slightly lethargic after a yelling spell however otherwise back to how she was prior to leaving scene.
Vitals: GCS-15, BP 150/80, HR 90 NSR, RR 16 R/F, SPO2 100% on non-rebreather, monitor and 12 lead show sinus rhythm.
This call was run with BLS medics to local facility, stroke centre 15+ minutes longer, psych 10+ minutes longer and large full service centre is 45+ longer transport time.
Just wondering what the community here would have done from BLS/ALS stand point and what everyone thinks is going on. This call made me change the way I look at psych calls as me and my partner were 100% OK with signing this lady off and driving away had the family not talked her into going.
46 y/o female found supine at cottage covered in a towel. Pt states she was going back and forth between the hot tub and cold shower to boost her immune system when she felt weak suddenly and boyfriend lowered her to the floor where she laid unconscious for 2+ minutes. Pt is emotionally upset (more than to be expected), and appears to be anxious and has a Hx of the same. Pt released from local psych unit after an 8 day stay for manic depressive episodes. Pt states for last 4 days at hospital she had a headache which was not treated by staff. No cardiac or neuro history. Pt takes daily anti-depressant (can't remember name, not TCA) as only medication, no allergies, last meal was the previous night.
Initial vitals while supine:
A/O x 3, BP 160/90, HR 112 NSR, RR 18 R/F, SPO2 98% on RA, BGL 5.6mmol/L
12-lead non-diagnostic, sinus tach, unremarkable.
Patient adamantly refusing to go to hospital and being extremely dramatic throughout call. Family arrives and finally pt is talked into transport. In a fit gets up and agrees to go to hospital with EMS (as my partner is preparing the sign off paperwork) and storms out of the house on her own accord. Pt lays semi-sitting on stretcher, vitals are unchanged.
We depart scene and get about 3 house lengths down the road when the pt becomes unresponsive.
Vitals: GCS-3, BP 130/70, HR 48, RR 8 Regular and clear with airway positioning, Patient accepts OPA, no gag reflex. SPO2 98% on RA
Monitor shows sinus brad, 12 lead confirms sinus brad, otherwise unremarkable.
OPA is inserted and ventilations assisted with BVM, priority upgraded, FD requested to meet up en route (volunteer agency). FD arrives and is loaded into the back. 2 minutes later (12 minutes unresponsive at this point), Pt sits up on stretcher, pulls out the OPA with a large gag and starts swearing and yelling. Pt is now GCS-15 alert to person, place and time and is slightly lethargic after a yelling spell however otherwise back to how she was prior to leaving scene.
Vitals: GCS-15, BP 150/80, HR 90 NSR, RR 16 R/F, SPO2 100% on non-rebreather, monitor and 12 lead show sinus rhythm.
This call was run with BLS medics to local facility, stroke centre 15+ minutes longer, psych 10+ minutes longer and large full service centre is 45+ longer transport time.
Just wondering what the community here would have done from BLS/ALS stand point and what everyone thinks is going on. This call made me change the way I look at psych calls as me and my partner were 100% OK with signing this lady off and driving away had the family not talked her into going.