# Still Alarm



## RedAirplane (Feb 27, 2015)

I am absolutely pleased with the amount of discussion given to scenarios on this forum, and the amount I can learn from your responses. Here is another one that is an amalgamation of things I have seen, scrubbed to protect privacy.

You are at an out-of-town conference when you hear a friend (with whom you are traveling) call you out by name. You politely exit the conversation you are having and turn around to see the buffet table is knocked over with food all over the place. After a minute you realize that there is an elderly man who collapsed into the table. It looks like he hit his head against a cement block upon falling, but it also looks like a platter of cakes cushioned his fall significantly. (Fate is enforcing your diet).

(For simplicity, assume that in the state you are in, you have a duty to act, or that you have otherwise chosen to act).

C-spine?

You ask a trusted person to call for EMS, and he does so immediately. It doesn't look like there are any other victims. The patient is alert and oriented, skin is pale but not cool/clammy, and pupils are pinpoint (but it's extremely bright lighting and hard to really gauge reaction to light). The pt states his chief complaint is "I'm just a little dehydrated" and tries to get up, but is unable to. You calm and reassure him, and collect whatever medical history you can.

First responders show up on a little go-cart, but let you continue with the patient while they work on clearing a path for EMS to get in. Anything you want to ask them for? Oxygen or not?

The patient last ate/drank yesterday (or so he says) and denies any medical history, but a family member quietly tells you he was recently hospitalized for "depression" and that he takes some medications but she doesn't know what they are. You cover the patient with a blanket and take vital signs every five minutes (BP a little low, respirations and pulse a little fast, unchanged).

The patient vomits twice in the 25-35 minute wait for ALS/ambulance, which unfortunately is on a higher priority call which came in at exactly the same time. Anything else you want to do?

There's a growing crowd of onlookers. How do you want to deal with them?

And, my personal weak point, how do you hand off the patient when the ambulance crew finally arrives? I have all the info, how do I make a cohesive sentence instead of babbling? 

(Whatever you did, you did a good job. The ambulance crew copies down your contact information under "first responder" and the next day you get a call from the local fire chief, who thanks you and invites you to visit his city/town again).

And if you had to venture a guess, what's going on with this pt?


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## Flying (Feb 27, 2015)

Ehhhh, no immobilization/restriction, ditch the oxygen. Can't really venture any guesses without a history.

Ignore the crowd. Get prepared for the clapping.

As for the hand-off, take half a minute to rehearse it with yourself. This will make it infinitely easier. Train yourself to speak in plain English and nothing else.
"Hey guys, this is Lou, he's 67. He collapsed onto that table and possibly hit his head. He says he is dehydrated and has vomited twice in the past half hour... denies history, but family member says he takes unspecified meds...."


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## DesertMedic66 (Feb 27, 2015)

No where near enough information to tell what is going on with the patient. As an off duty provider who, in this case is forced to help, there isn't much you can do. Since he can't get up then leave him laying down for the time being. Clear C-spine if your protocols allow. O2 probably won't help him very much but it probably won't harm him either.

If I was off duty I would probably just do a stroke scale. 

For handing off info just make it a story. "This is John Doe, he is 83 years old. He was standing at the buffet line loading his plate up when he had syncopal episode. He may have struck his head on this block on his way down but his landing was cushioned by my dessert. This is his C/C _____. These are his associating symptoms and pertinent negatives. These are his vitals ______. This is his SAMPLE history. This is what I did for him."


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## triemal04 (Feb 27, 2015)

If you were at the typical EMS conference you wouldn't have been able to reach the patient in the first place...to many wannabe hero's flocking to the scene and screaming for backboards/AED's/oxygen/IV's and the good old standby "I'm a EMT from BFE...I'M IN CHARGE!


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## RedAirplane (Feb 27, 2015)

Thankfully the theme of this imaginary conference is about books.


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## Angel (Feb 27, 2015)

lol, uh itd be nice to get actual numbers. (BP is a little low-how low?) but id do what desert said, clear cspine, i imagine if he hit his head on a brick thered be a lac of some sort that would need to be investigated.


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## RedAirplane (Feb 27, 2015)

Your guess is as good as mine at this point in the scenario, but let's call the BP around 110/P.


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## BlueJayMedic (Feb 28, 2015)

Every intervention from a first response has been done here. You said vitals were stable.  There is no way to tell what is going on with the history and what has been provided without any further diagnostics. 12-lead? BGL? New depression Dx, does that come with new Rx? We don't know the name of the med (if there is one) so impossible to tell the side effects, dosing of this new med? Patient compliant with any other meds? Neuro exam since he is unable to stand? 90% of this is all secondary en route with definitive Dx with blood work, cardiac work up and CT. A list of differentials for the patient is a mile long with whats been given. Hand off and carry on with your day.


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## Ewok Jerky (Feb 28, 2015)

Seeing as I'm off duty I don't have any thug to assess with or to intervene with. No O2 indicated. Would like a BGL though. Guy seems stable sounds like a syncopal or orthostatic issue. would like to know if he has any cardiac Hx either recent or remote. As long his mental status is ok and vitals are stable I will keep him on the ground as long as he is comfortable, NPO and chat with him till the cavalry arrives.

"this is John Doe X y/o male with a witness fall into this table w/o LOC but seems to have hit his head here, bleeding is controlled. He says he is dehydrated and hasn't eaten or drank since yesterday.  Denies medical history other than depression which is being treated with an unknown med. No allergies. Vitals are stable at *** on physical exam I might have found some trauma but who knows. My name and cert? Oh no I'm just a fortunate soul lucky enough to have been able to keep this gentleman company until the real heros arrived. Have a good day!"


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