Crashing airway patient

R

Rialaigh

Forum Asst. Chief
592
16
18
Dispatch comes out for "breathing problems". Notes state 52 year old female. Address is in a not great area of town. You have a 6 minute response time. No other notes in the CAD, you are on a double medic truck and you also have QRV back up coming to you about 1 minute behind you and fire responders as well.

Upon arrival you are in a poorly lit trailer park, patients husband is yelling from the porch. You can see from the ambulance patient is sitting on porch of trailer holding onto the rail. Initially patient appears in severe respiratory distress, husband states "she is having trouble breathing", no other information available.

Go...
 
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,107
6,850
113
History, All vital signs, including end tidal nasal capnography, skin, work of breathing.
Medication list from in the house. (You KNOW there is one, because ...trailer park.)

Depending on the distress, assist with a BVM, but I can't go down a treatment route til I know what the story is.
 
S

StCEMT

Forum Deputy Chief
3,052
1,709
113
Everything DE said...
 
cprted

cprted

Forum Captain
389
183
43
DE's post + Lung sounds? Respiratory pattern?

When did this start? Sudden onset or gradually getting worse? Any associated pain (chest or otherwise)?
 
PotatoMedic

PotatoMedic

Has no idea what I'm doing.
2,705
1,544
113
Patient on gurney and back of rig. CPAP if able. Lung sounds med list/med box or bag. Sample. IV cardiac monitor. Meds dependent on findings. Start doing math for RSI.
 
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,107
6,850
113
FireWA1 said:
Patient on gurney and back of rig. CPAP if able. Lung sounds med list/med box or bag. Sample. IV cardiac monitor. Meds dependent on findings. Start doing math for RSI.
Click to expand...

You shouldn't even thing about going that far until you hear what the story is.

Imagine this is the continuation of the scenario, When you walk onto the porch you see that the patient is in significant distress, gasping for breath, with shallow respirations around 50 per minute. There's a strong odor of alcohol and cigarette smoke about her person. She appears to be disheveled and unkempt. The trailer is in a similar state. The husband/boyfriend, clad only in a wife beater, boxer shorts and a smoldering Marboro red keeps screaming "she can't breathe you muthafukkas do something!"

Does she still get schlepped to the truck, CPAP and RSI math?

As your partner gets an end tidal CO2 cannula on the patient and the rest of the gear, you see sinus tachycardia at 130, SpO2 of 100% and end tidal of 19 with a flat expiratory plateau.

Still want CPAP?

As you start to work on de escalation and figuring out what the actual fck is going on, the husband shouts out, "man, her brother just got arrested for murder!"

Don't jump until you know what you're jumping into.
 
VentMonkey

VentMonkey

Family Guy
5,729
5,043
113
I realize there's no other info provided by family/ bystanders on scene, but what's this patients GCS on arrival?

Will they be able to tolerate CPAP? Can they be successfully oxygenated and ventilated with less invasive measures (CPAP--->BVM) before electing to utilize RSI?

A blood glucose and pupillary check will also be good to know before a straight away to aggressively managing their airway.

Obviously, as others have mentioned breath sounds and RA waveform pleth SPO2 and ETCO2 monitoring are excellent supplemental diagnostic guides in this patient population.

Given you're scenario, it sounds like impending respiratory failure, but again, a bit more info with our (your) measures once we (you) arrive will tell us how aggressively we need to manage their airway. Also, the ETA to our closest ED, and do we even have the ability to perform RSI here?
 
VentMonkey

VentMonkey

Family Guy
5,729
5,043
113
DEmedic said:
You shouldn't even thing about going that far until you hear what the story is.

Imagine this is the continuation of the scenario, When you walk onto the porch you see that the patient is in significant distress, gasping for breath, with shallow respirations around 50 per minute. There's a strong odor of alcohol and cigarette smoke about her person. She appears to be disheveled and unkempt. The trailer is in a similar state. The husband/boyfriend, clad only in a wife beater, boxer shorts and a smoldering Marboro red keeps screaming "she can't breathe you muthafukkas do something!"

Does she still get schlepped to the truck, CPAP and RSI math?

As your partner gets an end tidal CO2 cannula on the patient and the rest of the gear, you see sinus tachycardia at 130, SpO2 of 100% and end tidal of 19 with a flat expiratory plateau.

Still want CPAP?

As you start to work on de escalation and figuring out what the actual fck is going on, the husband shouts out, "man, her brother just got arrested for murder!"

Don't jump until you know what you're jumping into.
Click to expand...
Bah! Ya' beat me to the punch:eek:...
 
S

StCEMT

Forum Deputy Chief
3,052
1,709
113
Handsome Robb said:
My vote is to crich.


Sent from my iPhone using Tapatalk
Click to expand...
Like this?
CLIC-EM+BVM+Spike+Cric.jpg
 
PotatoMedic

PotatoMedic

Has no idea what I'm doing.
2,705
1,544
113
True I went down the respiratory route feet first before getting further info. But I do think doing drug math for an RSI when I put someone on CPAP is a good idea. Do I expect to do it? No, but I will start developing a plan if the CPAP does not improve or stabilize the patient.
 
DrParasite

DrParasite

The fire extinguisher is not just for show
6,197
2,053
113
FireWA1 said:
Patient on gurney and back of rig. CPAP if able. Lung sounds med list/med box or bag. Sample. IV cardiac monitor. Meds dependent on findings. Start doing math for RSI.
Click to expand...
honestly,this is my line of thinking too.

you meet me outside, meaning you walked all the way to the front door, another few steps to my cot probably isn't going to kill you. If you look sick, you might actually be sick, and even if not, odds are you going to the hospital with me, so I might as well take you into my office where I have all my equipment within arms reach. Also gives me the ability to leave the scene quickly and have some privacy if needed.

Assess the patient and treat as indicated based on findings. But yes, I'm getting her into the back of my truck as soon as I can, since she has met me on the porch.
 
ERDoc

ERDoc

Forum Asst. Chief
546
616
93
You guys are clearly missing a straight forward case of respiratory anthrax.

Hard to say what to do until we have a little more info. The pt sounds sick but we need to get some more info.
 
You must log in or register to reply here.
Top