Altered LOC. Diabetic Pt with known Hx of Narc OD

[JPINFV]

I'd love to sit down with a bunch of gear carried on an ambulance and Apollo 13 a solution to regulating warm fluid infusions.

Urinal, bottle of water or saline, hot pack.

Activate hot pack and put in urinal. Feel urinal with water. Put IV tubing into water to add heat. Add/remove line in order to modulate temperature.

 

[Melclin]

Urinal, bottle of water or saline, hot pack.

Activate hot pack and put in urinal. Feel urinal with water. Put IV tubing into water to add heat. Add/remove line in order to modulate temperature.

I always figured it would be coiled IV tubing sitting between two hot packs on the pts chest next to the IV site with the pre-warmed bag hanging just above. I'd love to test it properly though, with different ambient and starting fluid temps. I was ganna do some formal experiments last summer but they attached me to a very academic disaster medicine thing which was interesting but much less...er..hands on.

As far as measuring the temp of the saline going in, I wonder if a tympanic probe pressed into the bag would provide a reliable estimate of the temp or at least a number that could be plugged into a short formula... fluid t. = tympanic t. + 2/3(typanic t. - ambient t.)

/thread hijack

 

[Veneficus]

not so theraputic hypothermia

one problem at a time.

There are a lot of "If's" but this guy is definately hypothermic. So let's look at that first.

I would give him some heated fluid, hopefully through the EJ. (onboard heat on high works for me, you can make a box rather hot rather fast.)

I'd also make sure he was not wearing wet cloths, and if his hair was wet, I would make a quick effort to dry it a bit with a towel.

(For some reason I cannot explain, drug users seem to think that when somebody OD's, the solution is to put them in a tub full of ice water. I don't know where that originated from but I have seen it many times and it is not a local event)

If he alreay was dry, then he gets the blankets and the warm packs, etc. Yea there are some other tricks in the hosiptal, but it is most likely going to start this way all the same. Probably with a central line, but a large caliber EJ would be just as good.

Once you have started cooking him a little, you know, plug the AED on if you are not a medic unit.

From there, I would attempt to reheck the glucose. If he has peripheral stasis, it might be erring because it really cannot read, not that it is low or high.

After that, we could guess all day, did he take insulin? Too much? Too little? Did he try to shoot up and used an insulin syringe instead of his heroine, did he do the heroine an then insulin? Is he even on insulin? You see where all of this means absolutely nothing at this point?

You might even be able to get a reading from the needle flash in the EJ. Remember the one touch is meant to measure capilary or venous sugar, not total sugar in the blood. He may very well have plenty, but not circulating.

Could he save seized? yea, so what?

Could you give him some sugar of various formulation and help? Possibly.

How much would it hurt if the blood sugar was too high? Who can say? But I don't think very much unless you loaded a couple of amps of d50 into him.

Don't really see the need for narcan.

Yea, this guy probably has all kinds of issues. But few that will be helped in the back of a truck.

Just my thoughts. There do seem to be a lot of scenarios today.