# Werid call today



## wlamoreemtb (Jun 4, 2008)

OK so we get dispatched for unconscious woman. we arrive on scene pt on ground blood on face. bystanders say she was talking to them and just fell. now i call out to the pt no response. I shake her nr. sternal rub and other painful stimulus NR. She smelled of ETOH. medics arrives just as we were loading pt. vitals were 103/65 p84 o2sat 95 pupils sluggish resp. 22. medics came we got a history from her doctor who just happened to be on scene. medics took a blood sugar quick ekg and released to us. in rig pts resps went to 34 we bagged and inserted a npa. still NR from pt. pt had history or alcoholism depression anxiety etc. so we get to hospital and after I made report the charge rn tells us to put her in the hallway and leave. well the treatment rn came by yelled at us for putting her there. we moved her to the room and the rn begins to check pt. he was mad medics didnt transport with us and said this is something serious. we helped remove clothing and set up ekg. we left and I was extremely appauled by the actions of the charge nurse that told us to put her in the hall and leave her.


ANY thoughts on this. could it be Intoxication or something else I found the presentation to be unlike any other Alcohol related call ive been on and the fact the rn in charge told us to leave her in the hall infuriated me she was more worried about getting to the bank than the pt. I just thought i would share and get feedback


----------



## Ridryder911 (Jun 4, 2008)

Who knows? Sounds like another typical drunk.. now with that statement, alcoholic patients are difficult to manage and rule out. There are so many possibilities from a cerebral bleed to electrolyte imbalances. Again, a lot of waste time and money has to be made to only find out they were only drunk.... 

The uniqueness of this was the respiratory rate increased or was it the LOC increased with the respiratory rate? Alcohol is usually a respiratory depressant, not stimulant. 


Enjoy reading your post, but please review for simple grammar & capitalization, etc.. It makes it easier to read. 

R/r 911


----------



## Kate-Lynn (Jun 4, 2008)

wlamoreemtb said:


> OK so we get dispatched for unconscious woman. we arrive on scene pt on ground blood on face. bystanders say she was talking to them and just fell. now i call out to the pt no response. I shake her nr. sternal rub and other painful stimulus NR. She smelled of ETOH. medics arrives just as we were loading pt. vitals were 103/65 p84 o2sat 95 pupils sluggish resp. 22. medics came we got a history from her doctor who just happened to be on scene. medics took a blood sugar quick ekg and released to us. in rig pts resps went to 34 we bagged and inserted a npa. still NR from pt. pt had history or alcoholism depression anxiety etc. so we get to hospital and *after I made report the charge rn tells us to put her in the hallway and leave*. well the treatment rn came by yelled at us for putting her there. we moved her to the room and the rn begins to check pt. he was mad medics didnt transport with us and said this is something serious. we helped remove clothing and set up ekg. we left and I was extremely appauled by the actions of the charge nurse that told us to put her in the hall and leave her.
> 
> 
> ANY thoughts on this. could it be Intoxication or something else I found the presentation to be unlike any other Alcohol related call ive been on and the fact the rn in charge told us to leave her in the hall infuriated me she was more worried about getting to the bank than the pt. I just thought i would share and get feedback



Wouldn't that be considered abandonment? I don't know if I'm correct or not but from what I've learned it sounds pretty similar.


----------



## Ridryder911 (Jun 4, 2008)

Kate-Lynn said:


> Wouldn't that be considered abandonment? I don't know if I'm correct or not but from what I've learned it sounds pretty similar.




Not really, they have assumed responsibility of the patient. What they do and where the place the patient is their decision. 

R/r 911


----------



## KEVD18 (Jun 4, 2008)

its not even a "not really" R/r. its a flat no. 

you arrived at the er, gave your report to the triage nurse, and transfered the patient. its important to note that, along with the mechanical transfer of the patient, there is the transfer of the responsibility for the patient. 

now, was it appropriate conduct from the nurse. apparently not. but it wasnt abandonment.


----------



## mdkemt (Jun 4, 2008)

I deal with a large amount of chronic alcoholics where I work.  A lot of them have a history of cardiomyopathy.  I have had a few of these calls like you described and I would say about 95% of them are a cerebral bleed of some sort.  The increase in resps. is what tipped us off the most.

MDKEMT


----------



## Kate-Lynn (Jun 4, 2008)

KEVD18 said:


> its not even a "not really" R/r. its a flat no.
> 
> you arrived at the er, gave your report to the triage nurse, and transfered the patient. its important to note that, along with the mechanical transfer of the patient, there is the transfer of the responsibility for the patient.
> 
> now, was it appropriate conduct from the nurse. apparently not. but it wasnt abandonment.



Oh ok. Like I said I wasn't sure...


----------



## mikeylikesit (Jun 4, 2008)

There is a large possibility that it may have been DKA with Kussmaul’s  respirations.


----------



## Jon (Jun 4, 2008)

mikeylikesit said:


> There is a large possibility that it may have been DKA with Kussmaul’s  respirations.


The OP said that ALS checked a BGL on the patient before releasing to BLS.

I'd be concerned about the sluggish pupils and aLOC for a BLS transport.


----------



## Ridryder911 (Jun 4, 2008)

mikeylikesit said:


> There is a large possibility that it may have been DKA with Kussmaul’s  respirations.



Kussmaul's ???????? What? Sudden onset? Never heard or seen DKA with acute onset. Even respiratory pattern of Kussmauls smells like acetone, not sweet like EtOH. Respiratory pattern of Kussmaul's are pretty unique and descriptive as well (deep can be confused with Biot's respiratory pattern), not usually really very tachypneic pattern again the reason of blowing of ketones to neutralize the pH. 

Many DKA patients will slowly go into a Diabetic Coma, usually caused by an underlying illness or associated symptoms i.e. vomiting, diarrhea, wounds, sepsis, burns, etc.. 

R/r 911


----------



## mikeylikesit (Jun 4, 2008)

Ridryder911 said:


> Kussmaul's ???????? What? Sudden onset? Never heard or seen DKA with acute onset. Even respiratory pattern of Kussmauls smells like acetone, not sweet like EtOH. Respiratory pattern of Kussmaul's are pretty unique and descriptive as well (deep can be confused with Biot's respiratory pattern), not usually really very tachypneic pattern again the reason of blowing of ketones to neutralize the pH.
> 
> Many DKA patients will slowly go into a Diabetic Coma, usually caused by an underlying illness or associated symptoms i.e. vomiting, diarrhea, wounds, sepsis, burns, etc..
> 
> R/r 911


Sudden onset...no. Rapid progression from what was once bareable, i believe it. i have had sudden onset of kussmaul's before when activity sparked the respirations, thats how i learned i was diabetic that day. most people can mistake hyperglycemia with the sesitivity to light, paranoia and dementia as a person veing drunk that is why itt was a possibility. DKA to a coma usually takes a few hours to a day in my experience.


----------



## Ridryder911 (Jun 4, 2008)

mikeylikesit said:


> Sudden onset...no. Rapid progression from what was once bareable, i believe it. i have had sudden onset of kussmaul's before when activity sparked the respirations, thats how i learned i was diabetic that day. most people can mistake hyperglycemia with the sesitivity to light, paranoia and dementia as a person veing drunk that is why itt was a possibility. DKA to a coma usually takes a few hours to a day in my experience.



I believe you were hyperglycemic way before you were DKA. Maybe for months, days prior to diagnosis. One of the evil things about Diabetes. The Kussmaul's was just the symptoms that finally presented you to realize such. Again, DKA takes a long time for progression. Review pathophysiology of the metabolism of acid base relationship. As well, do not confuse Kussmaul's has to be present for DKA. Again, I have seen hundreds of DKA without Kussmaul's, also very, very few true Diabetic Comas (which have a high mortality rate) and is almost always associated with an underlying problem other than the glucose level (one should find the underlying etiology of increased glucose). 

Again, review why the difference of hypoglycemia and hyperglycemia. Most presentations of such is associated with hypoglycemia due to the lack of glucose molecule not being able to be metabolized at the cellular level in the brain. Where as the hyperglcemia may present some of those symptoms, it is almost always associated with the inability to metabolize the glucose and therefore use the fat (causing the ketone smell) and alteration in pH. The light sensitivity, irritability is again usually from alteration in pH causing an electrolyte change as well. Increased K+ and decreased Na+ will affect nervous systems, thus altering nervous system such as retinal nerve, and changes in mood. Again, review the buffer systems in which order occurs first and last. Respiratory is after attempts is made per homeostasis of the rest of the body.


----------



## mikeylikesit (Jun 4, 2008)

Ridryder911 said:


> I believe you were hyperglycemic way before you were DKA. Maybe for months, days prior to diagnosis. One of the evil things about Diabetes. The Kussmaul's was just the symptoms that finally presented you to realize such. Again, DKA takes a long time for progression. Review pathophysiology of the metabolism of acid base relationship. As well, do not confuse Kussmaul's has to be present for DKA. Again, I have seen hundreds of DKA without Kussmaul's, also very, very few true Diabetic Comas (which have a high mortality rate) and is almost always associated with an underlying problem other than the glucose level (one should find the underlying etiology of increased glucose).
> 
> Again, review why the difference of hypoglycemia and hyperglycemia. Most presentations of such is associated with hypoglycemia due to the lack of glucose molecule not being able to be metabolized at the cellular level in the brain. Where as the hyperglcemia may present some of those symptoms, it is almost always associated with the inability to metabolize the glucose and therefore use the fat (causing the ketone smell) and alteration in pH. The light sensitivity, irritability is again usually from alteration in pH causing an electrolyte change as well. Increased K+ and decreased Na+ will affect nervous systems, thus altering nervous system such as retinal nerve, and changes in mood. Again, review the buffer systems in which order occurs first and last. Respiratory is after attempts is made per homeostasis of the rest of the body.


oh i know, usually the repiratory system is the bodies last attempt at neutralizing the bodies Ph levels. the buffer changes the PH level by turning a strong acid such as OH+ to a waeker one like a bicarbonate ion. either way it all revolves around  H+ concentration the more H+ the lower the PH. i do believe i'm not sure it has been a while since A&P but Metabolic acidosis is commonly associated with not only diabetics but alcoholism as well. In this case of a metabolic origin the respiratory system would take over...i don't remember know why i brought this up.


----------



## Ridryder911 (Jun 4, 2008)

Actually, because alcohol and Diabetes have some similar problems with the break down of enzymes of fat and metabolism in the liver. One of the reasons Native Americans have a predominant gene and problems associated with both diseases. Both produce by-products that can definitely cause an increase in ammonia levels and metabolic acidosis... etcetera.

R/r 911


----------

