You are dispatched to a sick patient. Dispatch information is that your patient is a 22 year old patient who "seems sick". You are working on an ALS ambulance, you and your partner are both paramedics of equal clinical authority.
On scene, the patient's mother and father guide you in to a well-kept house. They called you because the pt. seems very lethargic and is slow to respond. They tell you that the patient has chronic back pain and was having trouble sleeping last night so she took some pain medications to try to go to sleep. You find the patient sitting in a kitchen chair, she looks like she is asleep. Her head is down with her chin to her chest and you notice there is a reddish syrupy liquid spilled on her face and down the front of her shirt. The bottle on the table next to you is Tussionex, and by your powers of deduction you establish that that's what is also spilled on the patient. Here's your initial information:
28 year old female
PMH: Chronic back pain, depression. No diabetes, no seizure history, no cardiac or respiratory history.
Meds: Parents aren't sure what she takes, but they bring you what they can find...Norco, Tussionex, Prozac...and some OTC supplements and stuff, not important
NKDA per family
BP: 74/40 manual
HR: 140
RR: 40-50, pt. does not slow her breathing in response to coaching
SPO2: 85% on 15lpm NRB
ETCO2: Varying between 55-65
Lung Sounds: "Junky"
BGL: Normal, lets say 100
Temp: Normal, let's say 98.5.
Pupils: Constricted, 1-2mm and reactive
Pain scale: Unable to obtain due to mental status
ECG: Sinus tachycardia, 12-lead unremarkable
Mental status: Responsive to loud verbal stimuli, GCS=11 for incomprehensible verbal. Pt. barely opens her eyes when you yell and will obey commands somewhat.
Skin: Pink, cool, dry
Physical examination: Unremarkable except what's noted above. No incontinence. No signs of trauma observed. No MedicAlert tags.
Parents deny any history of drug/alcohol abuse and aren't aware of any life changes that may have made the patient more depressed/unstable than normal.
An IV has been established. What's your next move/questions?
On scene, the patient's mother and father guide you in to a well-kept house. They called you because the pt. seems very lethargic and is slow to respond. They tell you that the patient has chronic back pain and was having trouble sleeping last night so she took some pain medications to try to go to sleep. You find the patient sitting in a kitchen chair, she looks like she is asleep. Her head is down with her chin to her chest and you notice there is a reddish syrupy liquid spilled on her face and down the front of her shirt. The bottle on the table next to you is Tussionex, and by your powers of deduction you establish that that's what is also spilled on the patient. Here's your initial information:
28 year old female
PMH: Chronic back pain, depression. No diabetes, no seizure history, no cardiac or respiratory history.
Meds: Parents aren't sure what she takes, but they bring you what they can find...Norco, Tussionex, Prozac...and some OTC supplements and stuff, not important
NKDA per family
BP: 74/40 manual
HR: 140
RR: 40-50, pt. does not slow her breathing in response to coaching
SPO2: 85% on 15lpm NRB
ETCO2: Varying between 55-65
Lung Sounds: "Junky"
BGL: Normal, lets say 100
Temp: Normal, let's say 98.5.
Pupils: Constricted, 1-2mm and reactive
Pain scale: Unable to obtain due to mental status
ECG: Sinus tachycardia, 12-lead unremarkable
Mental status: Responsive to loud verbal stimuli, GCS=11 for incomprehensible verbal. Pt. barely opens her eyes when you yell and will obey commands somewhat.
Skin: Pink, cool, dry
Physical examination: Unremarkable except what's noted above. No incontinence. No signs of trauma observed. No MedicAlert tags.
Parents deny any history of drug/alcohol abuse and aren't aware of any life changes that may have made the patient more depressed/unstable than normal.
An IV has been established. What's your next move/questions?
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