# Person Down



## FF/EMT Sam (May 24, 2008)

You are driving down Main Street of your rural town when you see a person lying face down in a yard with a man bending over the person, talking on a cell phone.  You look around for obvious scene safety threats, and, finding none, pull up, and identify yourself as an EMT.  The man on the phone tells you that he is currently on the phone with the 911 operator.

Your patient appears to be a young (late 20s-early 30s) female.  In the grass around her are a small billfold, a cell phone, and a bag of candy.  She is dressed in flip flops, shorts, and a t-shirt, which makes sense since many people like to walk or jog in this neighborhood, and it is a nice day.  She does not respond to your verbal prompts.  She is face down and you cannot tell for sure whether or not she is breathing while she is in that position, so you roll her face up.  You then find that she is breathing, but is unconscious and completely unresponsive, even to painful stimuli.

Although there are several bystanders, no one saw her go down.  The man who called 911 tells you that he arrived on scene 3 minutes (he checked his watch) before you did.  He claims that her condition has not changed since he found her.

You have with you a jump bag of basic supplies.  A volunteer station is being paged, but you don't know how quickly they will respond or arrive on scene.  

What do you do?  (More info available upon request).

EDIT: I tried to put this in "scenarios" and somehow failed...Can someone with the power to move threads please do so?


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## ffemt8978 (May 24, 2008)

Moved to appropriate forum per request


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## phunguy (May 24, 2008)

You say she is breathing, how is the breathing? rate, rythym, quality? Does she have a pulse? If breathing is wheezing maybe she has a candy stuck in her throat. Open her airway, head-tilt/chin lift, look in her mouth do you see anything,  begin chest compressions (since we don't do abdominal thrusts) and try to dislodge it.

Watch the airway, watch breathing, watch circulation, rapid trauma assesment (just in case the sniper down the road shot her).. Ask the bystander what he saw, check her wallet and wrist and necklace for medical ID (candy maybe she needed the sugar for diabetic).. 

If shes breathing and has a pulse and skin coor/temp/cond is stable all I can say is watch for any change and maintain an open airway by placing her on her left side. Wait for an ambo to arrive and transport..


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## AnthonyM83 (May 24, 2008)

How are ABCDE's?
Airway clear? Breathing rate and quality? Lung Sounds? Radial pulse rate/quality? Skin signs?

Obvious Injuries/Deformities upon your trauma assessment? Pupil's? Is she on a front lawn? Anyone home? Anything shady about the bystander? Is PD on the way?

I'd get through all of that before grabbing anything from the BLS kit. Have bystander maintain c-spine.


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## ERnurse17 (May 25, 2008)

2 mg of narcan IV. sign release and on to next call


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## BossyCow (May 25, 2008)

ERnurse17 said:


> 2 mg of narcan IV. sign release and on to next call



Wow, that would sure mean you would have missed the gunshot wound then wouldn't it!

I'd have LEO and ALS on the way.Not enough information to make a good guess... start ruling things out. Does she have any bleeding? Trauma? Is her airway good or obstructed? Breathing but how much and how well? Skin color, condition? Is she diaphoretic? Clammy? Hot? Was she hit by a passing car?

Depending on the answers to those questions during a rapid assessment, possibly assist breathing with a BVM if needed, get a glucose reading. O2, using the info on her perfusion level to determine the flow and method of O2. 

I'd probably load and go pretty quickly and do the bulk of my assessment in the back of the rig, but I'm 30+ minutes from the closest hospital and a head start is generally a good idea.


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## mikeylikesit (May 25, 2008)

:unsure:Whats the skin look like, how hot is it. the candy...is she a diabetic? check BS if you have equipment  to do so and check heat stroke symptoms. if stroked start IV of fluids. if she is hypersalivating put her in the recovery position. apply o2 via NRB and insert OPA. hard to say on this one. but at least you can cover your A$$.


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## FF/EMT Sam (May 26, 2008)

Your physical exam reveals no abnormalities, but you do notice a bracelet identifying her as an asthma patient.  LEO reports that her billfold contains an ID, but no medical information.  

Vitals are as follows:

BP: Very hard to hear due to passing traffic, but you can palpate it at 120/P
RR: 38 and shallow.  You manually open her airway and her respirations become 24 and normal.  You do not have any OPAs or NPAs with you.
P: 60, weak and irregular
Pupils: Equally reactive
Glucose and O2 levels are unavailable since you don't have the equipment needed to measure them.

You cannot see any obstruction in her airway.

You're not getting any bad vibes off any of your bystanders.

An ALS ambulance crew has responded with a 4 minute ETA.  Is there anything else you want to do for this patient or information you want to gather for the ambulance crew?  And do have any other guesses as to what's going on?


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## Airwaygoddess (May 26, 2008)

*Hey You!*

Long time no see!!  Welcome back FF/EMT Sam!  ^_^^_^


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## mikeylikesit (May 26, 2008)

asthma, does she have her meds with her? has she already taken any? my guess is no by the heart rate and RR. find out if she has allergies  and when she last ate.


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## fma08 (May 27, 2008)

lung sounds? and PEARL but at what size? and like in the other thread i feel sorry for the basic service that cant take a blood sugar let alone an O2 sat. so put her on O2 anyway since it sounds like thats all you can do an wait for ALS. trauma scan revealed nothing.... oh an open airway with jaw thrust since unknown trauma. c-spine... initial assessment and vitals every 5. see if anyone knows her well enough to get a HX from.


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## fma08 (May 27, 2008)

and what did you say skin color, condition and temp were? any signs of anaphylaxis noted?


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## BossyCow (May 27, 2008)

Hmmm.. being an asthma pt myself, many of us have other allergies. Bee sting from a bee in her candy? Is she swelling at all? No bad vibes off bystanders isn't going to stop me from calling LEO on this one. Are you saying no visible signs of trauma in a head to toe PE? 

With an unconscious pt and an unknown cause or downtime, you need to rule out everything you can. No abnormalities isn't enough information for me. I would like to hear something like... her skin is pale, dry, clammy, hot, flushed, her eyes are perl, fixed, dialated, pinpoint... details.. I want details!

Road noise be damned. I want a full B/P and with no equipment other than a BP cuff, I got time to get it right. 

Best guess though is bee sting, possibly throat. Bee in the candy??


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## mikeylikesit (May 27, 2008)

yeah those candy bees suck, they always stick on my sugar babies^_^. seriously though i agree more than likely with the present condtions it would have to be an enviormental emergency.


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## AnthonyM83 (May 27, 2008)

What kind of candy?


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## BossyCow (May 27, 2008)

AnthonyM83 said:


> What kind of candy?



Would you like some candy Little Boy???


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## FF/EMT Sam (May 27, 2008)

I'll try to get to everything...

No signs of swelling anywhere.  No signs of trauma anywhere on her body.  Skin is slightly dry, but not to the point of being a major concern.  The candy is a bag of gummy bears, and it's not open.  You try the BP again and get 124/68.  

5 minutes after your arrival on scene (down time was at least 8 minutes total), your pt. begins to moan softly.  She opens her eyes slowly when you ask her to.  After another minute, she is more alert, although she's still a little slow to respond to your prompts.  

LEO and ALS ambulance arrive within seconds of each other 6 minutes after your arrival on scene.  One of the paramedics knows your patient and tells you that she has a blackout disorder, and that something like this episode happens once or twice a month.  

Your patient denies any pain anywhere and is transported to the hospital.  When she is loaded into the ambulance, her vitals are:
Pulse: 80 strong and regular
Respirations: 16 and normal
O2 Sat: 98% RA, 100% on 4L 02 via N/C.
BP: 130/74
Glucose: 95
She is showing a Normal Sinus Rhythm on the monitor.
By this time, she is alert and oriented.  She does not remember passing out, which she and the paramedic who knows her both confirm is normal.  

You later learn that her medications were adjusted by her doctor after this episode, and she has not passed out in the last six weeks.  She now has a new bracelet that mentions her blackout disorder.

I'm going to bed now...Unless something wonderful like catching the patient's blackout disorder happens to me, I have to spend tomorrow in court.  Joy.


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## FF/EMT Sam (May 27, 2008)

Airwaygoddess said:


> Long time no see!!  Welcome back FF/EMT Sam!  ^_^^_^



Yes, I'm back after my ten month interlude in the high desert.  Lock your doors and hide your kids.  B)


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## mikeylikesit (May 27, 2008)

FF/EMT Sam said:


> Yes, I'm back after my ten month interlude in the high desert.  Lock your doors and hide your kids.  B)



Hopefully in that order, it would be a shame to lock my kids up just cause your back.


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## BossyCow (May 28, 2008)

mikeylikesit said:


> Hopefully in that order, it would be a shame to lock my kids up just cause your back.



I'm at that point in life where I'm more concerned about my kids locking me up!


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## mikeylikesit (May 28, 2008)

LOL, cocky little punks aren't they when they are as big or almost as big as you.<_<


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## DBieniek (Jun 1, 2008)

ERnurse17 said:


> 2 mg of narcan IV. sign release and on to next call



Are you stupid? What part of this scenario gave you enough information to rule out the more likely causes and treat for a drug overdose? I seriously hope you are not able to function on an ambulance.


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## NREMT08 (Jun 4, 2008)

What exactly is a black out disorder? and how could this disorder cause irregular pulse? or breathing?  Just a question, I am an EMT-B so I know that there is alot that I don't know, lol, just never heard of this before, so I thought I'd ask.


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## mikeylikesit (Jun 4, 2008)

Blackout disorder is commonly referred to as syncope disorder. Basically the person can go black suddenly and more than once a day it usually happens up to 15 time a day unexpectedly. Most usually don't pass out but are temporarily blinded, it is a neurological disorder. The heart arrhythmias and the episodes are completely unrelated as far as I know.


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## mikeylikesit (Jun 4, 2008)

DBieniek said:


> Are you stupid? What part of this scenario gave you enough information to rule out the more likely causes and treat for a drug overdose? I seriously hope you are not able to function on an ambulance.


*Naloxone or Narcan* is a drug used to counter the effects of opioid overdose, for example heroin or morphine overdoses. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system. So it can be used outside of an overdose.


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## Firemedic515 (Jun 4, 2008)

DBieniek said:


> Are you stupid? What part of this scenario gave you enough information to rule out the more likely causes and treat for a drug overdose? I seriously hope you are not able to function on an ambulance.



Chill out there DB.  That poster was obviously joking and it went right over your head.  I got a good laugh out of it.


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## Jon (Jun 4, 2008)

mikeylikesit said:


> *Naloxone or Narcan* is a drug used to counter the effects of opioid overdose, for example heroin or morphine overdoses. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system. So it can be used outside of an overdose.


Huh? Can you read that back to me? You said it is used to counter effects of opioid overdoses... but then said it can be used outside of overdoses... yet you don't make any case for saying this. I know you are trying to catch up to my post count... but this is a little bit much 

As for the first narcan comment... Firemedic beat me to it - The case was already made that that was not likely the most correct treatment, especially without a detailed assessment. I assume that the poster was attempting to use sarcasm.... but since they haven't replied, we don't know for sure. Let's move on to the APPROPRIATE TREATMENT OF THE PATIENT.


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## traumateam1 (Jun 9, 2008)

Well seeing as we know it's a blackout disorder I'll just say what I Would of done prior to ALS arriving, or knowing what was going on.
Get partner to take C-Spine and then roll her onto her back and then hand off to bystander on phone with 9-11. Advise dispatch that we are 10-8 (on scene) and need ALS code 3 (ya know, lights and sirens) for a unconscious unknown emergency. Hopefully my parner showed the bystander how to apply a proper Jaw Thrust. If not I would, then ensure airway is open, and observe for any possible foreign objects (candy, etc) or swelling (anaphylaxis) or liquids in the mouth. Then I would size up and insert an oral airway. After A is secure then I would do a breathing check - rate, quality, equal expansion, etc and determine if assisted ventilations were necessary. Check radial pulse and skin. Apply 02 at 10 LPM via non rebreather and go onto my Rapid Body Assessment to determine any possible traumatic injury and medical alert bracelet. After doing my RBA or RBS(rapid body survey) I would apply hard collar to patient, as we cannot rule out C-Spine. Treat any further life threatening problems, and hopefully if none go onto my secondary survey while awating for ALS car to arrive.

Did I miss anything? If I did let me know!
Mitch


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## mikeylikesit (Jun 9, 2008)

Jon said:


> Huh? Can you read that back to me? You said it is used to counter effects of opioid overdoses... but then said it can be used outside of overdoses... yet you don't make any case for saying this. I know you are trying to catch up to my post count... but this is a little bit much
> 
> As for the first narcan comment... Firemedic beat me to it - The case was already made that that was not likely the most correct treatment, especially without a detailed assessment. I assume that the poster was attempting to use sarcasm.... but since they haven't replied, we don't know for sure. Let's move on to the APPROPRIATE TREATMENT OF THE PATIENT.


Let me specify its other use; it can reverse the psychotomimetic (delusions, hualicinations and psycosis) and dysphoric effects of agonist-antagonists like pentazocine (which is in the opium class) basically what i am trying to say is that Narcan isn't just for overdoses that it can be used to help comeone settle down who i experiencing the forementioned effect fo opiod use.


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