LAS46
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This is a call was forwarded to me by a friend.
Dispatch: Snowmobile vs. tree accident. The patient has been taken into the local tavern.
Arrive to find: A 24 y/o female in the one stall bathroom. She is complaining of abdominal pain and vaginal bleeding.
Assessment reveals:
• Airway is open; patient is talking and crying.
• Breathing at 26 times/minute and shallow.
• Pulse is 110, weak and regular.
• Blood pressure 112/88
• Pupils equal
• Lung sounds clear, equal bilaterally
• Skin is pale, cool and clammy.
• History
• S- abdominal pain, vaginal bleeding, nausea
• A- PCN
• M- prenatal vitamins
• P- miscarriage 2 years ago, currently 12 weeks pregnant
• L- pizza and soda 1 hour ago
• E- Lost control of snowmobile going around a corner about 15 MPH.
• O- snowmobile hit the tree; she may have hit handle bars; she has been having cramping and spotting since yesterday
• P- worse when she extends her legs
• Q- cramping abdominal pain
• R- down to pelvis
• S- 6/10 scale; she states “I’m not a baby.”
• T- accident happened ½ hour ago; cramping and spotting since yesterday
• Injuries – Bruise to umbilicus area, gross red blood from vaginal area. Denies neck or back pain.
Treatment:
Basic: Oxygen, prevent further heat loss with blankets. Trauma dressings to genital area for vaginal bleeding. Spinal immobilization with legs flexed. Talk to and calm patient and boyfriend. Monitor patient for hypovolemic shock.
Patient Response: Patient feels better when treated for shock. Nausea continues. Patient continues to compensate:
Vitals:
pulse 118,
respiration rate 30,
BP 110/84.
SpO2 97% on 6 lpm via NC
ALS: Start an IV and titrate to maintain BP. Analgesia for pain if within protocols.
Higher Level Questions or Affective Issues:
B: When and if would you call ALS?
B/A: Would you address the previous miscarriage?
B/A: Would you expose and examine the genital area?
B/A: Would you transport patient on backboard?
B/A: Would you tilt the patient to one side? Which one?
B/A: How would you address the patient’s response to possible miscarriage?
A: What gauge catheter and IV tubing would you use?
A: What rate would you run the IV?
A: What analgesia would you choose to give? Why?
Dispatch: Snowmobile vs. tree accident. The patient has been taken into the local tavern.
Arrive to find: A 24 y/o female in the one stall bathroom. She is complaining of abdominal pain and vaginal bleeding.
Assessment reveals:
• Airway is open; patient is talking and crying.
• Breathing at 26 times/minute and shallow.
• Pulse is 110, weak and regular.
• Blood pressure 112/88
• Pupils equal
• Lung sounds clear, equal bilaterally
• Skin is pale, cool and clammy.
• History
• S- abdominal pain, vaginal bleeding, nausea
• A- PCN
• M- prenatal vitamins
• P- miscarriage 2 years ago, currently 12 weeks pregnant
• L- pizza and soda 1 hour ago
• E- Lost control of snowmobile going around a corner about 15 MPH.
• O- snowmobile hit the tree; she may have hit handle bars; she has been having cramping and spotting since yesterday
• P- worse when she extends her legs
• Q- cramping abdominal pain
• R- down to pelvis
• S- 6/10 scale; she states “I’m not a baby.”
• T- accident happened ½ hour ago; cramping and spotting since yesterday
• Injuries – Bruise to umbilicus area, gross red blood from vaginal area. Denies neck or back pain.
Treatment:
Basic: Oxygen, prevent further heat loss with blankets. Trauma dressings to genital area for vaginal bleeding. Spinal immobilization with legs flexed. Talk to and calm patient and boyfriend. Monitor patient for hypovolemic shock.
Patient Response: Patient feels better when treated for shock. Nausea continues. Patient continues to compensate:
Vitals:
pulse 118,
respiration rate 30,
BP 110/84.
SpO2 97% on 6 lpm via NC
ALS: Start an IV and titrate to maintain BP. Analgesia for pain if within protocols.
Higher Level Questions or Affective Issues:
B: When and if would you call ALS?
B/A: Would you address the previous miscarriage?
B/A: Would you expose and examine the genital area?
B/A: Would you transport patient on backboard?
B/A: Would you tilt the patient to one side? Which one?
B/A: How would you address the patient’s response to possible miscarriage?
A: What gauge catheter and IV tubing would you use?
A: What rate would you run the IV?
A: What analgesia would you choose to give? Why?
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