# A man/woman has collapsed...



## magicman (Dec 19, 2008)

Here is a scenario to further my learning as a first responder.
A woman collapses/faints in front of you at a coffee shop
You go to her aid and begin a primary survey. What does it mean if..

her pulse is high?
low?
breathing rate is high
low?
her skin is extremely cold and damp?

I dont feel confident handling a situation like this and want to know what you would do? Would you dial 911 and what can be done at the first responder level after the ABCs

Thanks


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## MRE (Dec 19, 2008)

As a first responder, and even if you were an EMT, quite often you won't know what is wrong with a person.  If somebody faints in front of you; call 911.  Do your survey, check consciousness, vitals, manage ABCs, treat for shock.


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## traumateam1 (Dec 19, 2008)

magicman said:


> Here is a scenario to further my learning as a first responder.
> A woman collapses/faints in front of you at a coffee shop
> You go to her aid and begin a primary survey. What does it mean if..
> 
> ...



There are way to many reasons a persons pulse might be high/low; high/low resp. rate. Extremely cold and damp skin? Cold water? 

Basically as a First Responder you have to think basic, as we are the basics of basic. Think: cardiac, diabetic, and medication.
As a First Responder basically...
Do your ABCs ->RBS/Rapid Trauma Assessment -> O2 and blanket if needed -> call for back up/transport.
Secondary Survey: SAMPLE/Vitals -> Detailed Head-to-Toe -> Treatment/Paperwork.
There isn't a whole lot you can do like taking a blood sugar, administering IV's, doing cardiac monitoring, etc etc. 
Treat all life threatening situations as you get to them:
If there is no A in your ABCs don't go to B until A is fixed, if you have A but no B, don't go to C until B is fixed (unless you are doing a pulse check to see if CPR is needed), etc etc.

Not a whole lot can be done like said before except make sure there is ALS/transport on the way. Get ready for them to: wake up, seize, vomit. You will become more confident as you attend to these calls.


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## traumateam1 (Dec 20, 2008)

Okay.. I don't like my old post. So I will try again.

Like said before.. there are many reasons someone is going to have a high/low pulse and a high/low resp. rate. As far as the extremely cold and damp skin.. well not much can cause extremely cold skin. Frostbite is one for instance.

As far as your protocols of what you can do, as said before:


Call for ALS back up/ transport
ABCs
RBS/Rapid Trauma Assessment
O2 and blanket (if needed)
Secondary Survey: History (SAMPLE/Vitals)
Head-to-Toe
Treatment
Paperwork

Don't forget to reassess your ABCs every 5 minutes if a critical/code 3 patient.

As far as the feeling comfortable, if you are new to the business, no one feels comfortable their first X amount of times attending to a serious call. You will get it tho, it will "just click", and your crew wont leave you hanging, they will help. Take deep breaths, try not to panic. 

You will do just fine. You have to have self confidence in yourself.

Good luck!


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## rhan101277 (Dec 20, 2008)

magicman said:


> Here is a scenario to further my learning as a first responder.
> A woman collapses/faints in front of you at a coffee shop
> You go to her aid and begin a primary survey. What does it mean if..
> 
> ...



High Pulse - Suspect the worst that pulse is high due to hypoperfusion, the body increases heart rate to compensate and keep the blood pressure up.

Low Pulse - This is an ominous sign especially in children.

High and low breathing rates, but on high flow oxygen via BVM, especially for breathing to slow.  I guess its possible to breath to fast, and just need NRB. 

Her skin being cool and damp is a sign of shock, her legs would need to be elevated and she would need to be kept warm.  So her body temp doesn't fall to much.

Ask co-workers around if they know is she has any history of illness, allergies, medications etc.  As you as you can keep heart breathing and her pulse going your doing the best you can, also treat for shock.


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## Outbac1 (Dec 20, 2008)

What it means is impossible to say. So much more info is needed to begin making a Dx. There is more to an assessment than just a persons pulse or breathing being high or low. I'm guessing when you said high you mean rate.

  The pulse  assessment should include rate, rhythm, and volume.  Is the rate slow, regular(normal), or fast? What is slow(<60), normal(60 - 100) or fast(>100)? Is the rhythm regular, irregular or regularly irregular? Does it feel strong or weak? 

  The same idea for their breathing. Fast, slow, quality. Fast(>24), slow(<12). Are they breathing deep or shallow? Are they moving enough air to be effectively breathing. 

  Numbers don't tell the whole story. Many people have normal heart rates less than 60. It all has to be considered with everything else the patient presents with. A patient who has a heart rate of 104 will probably get different Tx than one with a rate of 180. Yet both qualify as fast(tachy).

  History? Very important. A SAMPLE is good. Try to get details if possible. A pt who says they take a heart pill is only partly helpfull. If they can't name it try to get the name of the store where they buy their meds. 

  Bottom line, just do the best you can. Stay within your training and scope, and call for help as required. 

  PS: Welcome to the forum.


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## aidan (Dec 21, 2008)

magicman said:


> Here is a scenario to further my learning as a first responder.
> A woman collapses/faints in front of you at a coffee shop
> You go to her aid and begin a primary survey. What does it mean if..
> 
> ...



After calling 911 (yes, I would call 911.. almost always, if a person faints, I'd want to make sure an ambulance is coming to get them, or someone other than his or herself drives him or her to the hospital asap.) and doing ABCs, I'm not sure there's a whole lot else you could do.

I think the exact situation would change what the symptoms mean.. was she standing, or walking, and then fell to the floor? Or could she have been sitting down for a while, feeling ill, and then eventually passed out?

If she was tachycardic and had a high RR I would first suspect hypoperfusion..I'd check for signs of hypoxia. Make sure RR and TV are adequate, check fingernails, lips and conjunctivia for cyanosis (although I doubt it'd present that early.) Cold/clammy skin is a early indication of hypoxia, although I'm not sure if that's the same as "extremely cold and damp".

I'm not sure what it could be if she was bradycardic and had a low RR. In any event, I'd stabilize her the best I could with ABCs and wait for medics.


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## daedalus (Dec 21, 2008)

You want to be able to interpret data you get from vitals signs, you have to go to paramedic school. Building a DDx and assessment based management are paramedic level abilities. 

As a first responder (MFR or EMT both count here), you will want to keep this women flat, because syncope occurs when the brain needs to improve its blood flow. If you have oxygen you could apply a nasal cannula if she is in no apparent distress or a NRB mask if she is cold, tachypenic, in obvious distress, etc. You than could take initial vital signs, take a PMHx and Hx of the current event, preform a trauma exam to see if she had been injured, and than transport the patient or call for ALS to transport if that is available. 

According to the Journal of the American Family Physicians vol 72 no.8, "The underlying cause of syncope remains unidentified in up to 31 % of patients even after thorough evaluation"


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