Altered Mental Status Scenario

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CPRinProgress

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I am in a EMTB class in nj. Today we had a scenario where I, a first responder, respond to unknown medical. On arrival pt was sitting up against a wall. When I introduced myself the pt was obviously altered with no by bystanders. To open his airway I layed him down and applied o2. Checked CTC bleeding signs of shock etc. When others arrived someone did a rapid trauma while I took vitals. Pt had back neck pain so we back boarded. After my instructor asked why I played the pt down and I said I did it to open his airway but he said that was wrong. My question is how should I have managed the airway.
 
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If he was breathing on his own and maintaining his own airway (sounds like it if he's sitting up and talking), then don't do anything but put some oxygen on. Being confused isn't necessarily a reason to maintain his airway.

Sometimes scenarios are a little hard because you can't get a good picture of what the instructor is envisioning; they aren't always good at making it clear. It'll be a little more obvious on needs when it's a real patient and not a poor actor.
 
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PoeticInjustice said:
If he was breathing on his own and maintaining his own airway (sounds like it if he's sitting up and talking), then don't do anything but put some oxygen on. Being confused isn't necessarily a reason to maintain his airway.
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I guess I just did feel right to just leave it because in most scenarios they beet it in to us that we need to manage airway. How should we backboard a sitting pt just slide him onto the board and lay him down slowly?
 
Like poetic said, he's protecting his own airway and frankly, it'll be better protected with him sitting up allowing secretions or any emesis that presents to drain.

Did he have any trauma? Unfortunately the "gold standard" of prehospital trauma care (the backboard) is counter productive in patients with head injuries/increased ICP since, ideally, we want those patients sitting up at a 30-45* angle but that's not always possible.

Remember AEIOUTIPS.
 
Yeah, that would work. Just make sure you don't move anything more than it needs moving. Excess manipulation is a failure I believe.
 
Robb said:
Did he have any trauma? Unfortunately the "gold standard" of prehospital trauma care (the backboard) is counter productive in patients with head injuries/increased ICP since, ideally, we want those patients sitting up at a 30-45* angle but that's not always possible.
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I almost went there, but figured I'd let him out of class first :P
 
Robb said:
Like poetic said, he's protecting his own airway and frankly, it'll be better protected with him sitting up allowing secretions or any emesis that presents to drain.

Did he have any trauma? Unfortunately the "gold standard" of prehospital trauma care (the backboard) is counter productive in patients with head injuries/increased ICP since, ideally, we want those patients sitting up at a 30-45* angle but that's not always possible.

Remember AEIOUTIPS.
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After a rapid trauma, we found a glucometer so we administered glucose he started to come around and said he was upstairs and he fell down the stairs. I understand that if he is maintaining his own airway to leave it but his head was leaning forward so I figured that it had the potential to close and I thought the ams could have been caused by lack of oxygen. Just what I thought
 
CPRinProgress said:
After a rapid trauma, we found a glucometer so we administered glucose he started to come around and said he was upstairs and he fell down the stairs. I understand that if he is maintaining his own airway to leave it but his head was leaning forward so I figured that it had the potential to close and I thought the ams could have been caused by lack of oxygen. Just what I thought
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Well you're kind of contradicting yourself here. If he wasn't able to maintain his own airway and needed airway maneuvers, you wouldn't have wanted to give him oral glucose...
 
PoeticInjustice said:
Well you're kind of contradicting yourself here. If he wasn't able to maintain his own airway and needed airway maneuvers, you wouldn't have wanted to give him oral glucose...
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You are right he did start to come to after we gave oxygen but I shouldn't have laid him down
 
PoeticInjustice said:
Well you're kind of contradicting yourself here. If he wasn't able to maintain his own airway and needed airway maneuvers, you wouldn't have wanted to give him oral glucose...
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He could have given it rectally though, if needed.
 
Achilles said:
He could have given it rectally though, if needed.
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Yes, but I'm trying to keep the line of though consistent with EMT class and passing his scenarios. I've yet to see an EMT-B book that advocates that (they may, but I haven't seen it)
 
PoeticInjustice said:
Yes, but I'm trying to keep the line of though consistent with EMT class and passing his scenarios. I've yet to see an EMT-B book that advocates that (they may, but I haven't seen it)
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Well than you would want to inform the student not to give anything orally per AMS :P
 
PoeticInjustice said:
Yes?
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Well I was actually joking, hence the tongue sticking out. But since you pointed it out, you are correct. On the conterary, my statement is also factual.
 
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Achilles said:
Well than you would want to inform the student not to give anything orally per AMS :P
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Well We were told that we can give glucose to someone with ams as long as they are able to swallow.
 
God what a pain in the arse this sort of vocational education must be. All these absolutes that bear no relation to medical fact, common sense or the real world.

This reminds me of a person at uni who attended a pt who had smacked their head on an over head cupboard. She immobilised quoting head strike as the reason and stated the person couldn't be cleared on account of the laceration being a distracting injury. She just didn't seem to be able to wrap her head around the idea that not all head strikes were made equal. This was the same person who wasn't aware that MI and cardiac arrest were different things in second year uni. You've gotta wonder where she'd been for the past year and a half.

Anyways, I'm not having a go at you OP, but at a system that creates rules that you have to follow so rigidly that you jettison all common sense and reason and do things like maintain the airway of a person who is sitting up talking to you. "Always maintain the airway" comes with a caveat that remains unwritten because it is so obvious, "If the pt can't do it for themselves".
 
CPRinProgress said:
Well We were told that we can give glucose to someone with ams as long as they are able to swallow.
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Absolutely.

If you couldn't give oral glucose to someone who had an altered mental status, you'd just about never give it. If they didn't have AMS, you probably wouldn't be there :wacko:

The "can't give it to a person with AMS" is an over simplification. Its generally accepted that its not a great idea to give a PO drug if the pt is too out of it to swallow said drug. People can have all kinds of altered mental status and still swallow, although some may not. I suppose its just easier to make blanket statements like this when you've only got 15 seconds to educate a provider before they're out on the road. Obeying commands may be a good indicator. If you say, "Hey idiot, swallow", and they swallow, wicked good, give them some sugar.
 
CPRinProgress said:
Well We were told that we can give glucose to someone with ams as long as they are able to swallow.
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That is true. The reflexes that protect the airway are the "last to go", which is why even unresponsive patients often can't be intubated without sedation.

As long as the patient is not completely obtunded, chances are very slim that a small amount of glucose gel is going to cause an aspiration.


Melclin said:
God what a pain in the arse this sort of vocational education must be. All these absolutes that bear no relation to medical fact, common sense or the real world.

This reminds me of a person at uni who attended a pt who had smacked their head on an over head cupboard. She immobilised quoting head strike as the reason and stated the person couldn't be cleared on account of the laceration being a distracting injury. She just didn't seem to be able to wrap her head around the idea that not all head strikes were made equal. This was the same person who wasn't aware that MI and cardiac arrest were different things in second year uni. You've gotta wonder where she'd been for the past year and a half.

Anyways, I'm not having a go at you OP, but at a system that creates rules that you have to follow so rigidly that you jettison all common sense and reason and do things like maintain the airway of a person who is sitting up talking to you. "Always maintain the airway" comes with a caveat that remains unwritten because it is so obvious, "If the pt can't do it for themselves".
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Welcome to American EMS education :sad:

It's not the OP's fault. He is a layperson just doing as he has been trained, and probably somewhat confused by conflicting information in the curriculum. Things that seem really obvious and "common sense" to us often are not obvious to those without our experience.
 
Halothane said:
That is true. The reflexes that protect the airway are the "last to go", which is why even unresponsive patients often can't be intubated without sedation.

As long as the patient is not completely obtunded, chances are very slim that a small amount of glucose gel is going to cause an aspiration.




Welcome to American EMS education :sad:

It's not the OP's fault. He is a layperson just doing as he has been trained, and probably somewhat confused by conflicting information in the curriculum. Things that seem really obvious and "common sense" to us often are not obvious to those without our experience.
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The thing that annoys me is how the book is written by a bunch of doctors that have probably never been in the field and how there is nothing about improvisation in the book or that we even learn about. The real world have people falling in the smallest bathroom you have ever seen not the middle of a gym
 
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