BLS scenerio time

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certguy

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Don't you just hate it when your train of thought jumps the tracks??? What were we talking about ??? Oh yeh , the scenerio , okay , perp's dead , 2 officers down . Does the officer hit in the chest have his vest on ? Did he get hit with buckshot , a rifled slug , or maybe he got real lucky and it was birdshot . A dead center hit , even if it didn't get through , could produce internal trauma . We triage both officers , check ABC's , and go from there with appropriate treatment .


Hey Topher , sorry I gave you a bad time ( just in fun ) . It's good you're getting into the scenerios . They're good practice for your thought processes . What I was trying to tell you earlier and probably did a lousy job of it , was that sometimes new people can get too concerned with thier safety and go overboard . Don't fall into that trap . You can't always have PD with you and if you call them too often when they're not really needed , they could become complacent , think it's just another pain in the backside call and take thier time , which would be a really bad thing if you really need them . Over time , you'll develop your personal spidey - sense . That sixth sense that tells you something's not right here . If that happens listen to it , but be aware that sometimes you can't always tell a dangerous scene before you go in . Pts. can and will surprize you at times .
 

gcfd_rez31

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New Pt

Call time: 2245

ALS rig dispatched to approx 55 y/o female, welfare check. Pt hadn't been heard from in days, and neighbors were getting worried.

Crew is thinking that pt isn't going to be doing so well when they arrive on scene. [OBVIOUSLY...]

Crew arrives on scene to find pt laying in her bedroom (unattended). There is urine, pecies, vomit, and blood on the floor. Pt not moving.

BP = 100/P
SpO2 = 88
RR = 12 shallow
HR = 72 tacky


any questions??? lemme know..... GO!
 
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certguy

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Okay , first things first . Is the scene safe ? Is there any evidence of a possible crime scene ? Is the pt. conscious ?What am I looking at on assessment ? Where's the blood coming from ? Does she have a medic alert tag / vial of life ?
 

BossyCow

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She's breathing, but not well, hearts beating, but not effectively...

What's her general appearance, skin color, visible injuries? What is going on around her.. sign of struggle, fall, gun? Where's the blood coming from?

While I'm waiting for your answers on this, I would have her on O2, NRB cranked up.. I'd have ALS on the way, and be hooking up the monitor. I'd be checking a temp, doing a Blood glucose check. At this point.. just trying to get as much infomation as possible... I'd have someone looking for pill bottles.. to see what meds she's taking for an indication of possible med hx. I'd want her in the rig moving towards ALS as fast as possible.

Without knowing the location of the bleeding or volume. is it from a rectal bleed? Trauma? Vomiting? Stoma issues?

Oh wait.. are the body fluids hers??? lol
 

AZFF/EMT

Forum Lieutenant
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I would assure my own safety/BSI.
Unknown reason the patient is on the ground so C-spine precautions at least to start. Is she supine or prone?
I would move her on to a backboard(support for cpr if needed, she sounds like a pre-coder to me.

A-Check her airway, prepare to suction if any vomit remains inside.
B-High flow o2, consider dropping an OPA if she'll take it, if not NPA.
C-If pulse is weak and thready(not tachy at 72?) Hope o2 helps and monitor her.

Obtain as much info from the scene as possible, meds, alert tags, family if around(someone called 911)

I would want a blood sugar.

If your medics can start lines I would set-up for an IV.

What other finding are there?
 

wolfwyndd

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I THINK HR = 72 TACKY Means Heart Rate is 72 and tachycardic.
HOWEVER, I'm not sure how someone could consider a heart rate of 72 as tachycardic. Generally tachycardic isn't considered till it gets to about 100 beats per minute. I'd consider 72 closer to bradycardic, which is about 60 beats per minute or less.
 

skyemt

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I THINK HR = 72 TACKY Means Heart Rate is 72 and tachycardic.
HOWEVER, I'm not sure how someone could consider a heart rate of 72 as tachycardic. Generally tachycardic isn't considered till it gets to about 100 beats per minute. I'd consider 72 closer to bradycardic, which is about 60 beats per minute or less.

72 is not bradycardic, nor tachycardic...

i don't think in adults tachycardia is a relative term... i think it is HR above 100...

did the poster mean thready?
 

gcfd_rez31

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sorry everybody on the tacky. i meant thready... (someone around me said tacky and i typed it lol)

anyways...

scene IS safe.

skin color = pale
no visible injuries.
no gun or weapon.
blood came from vomit.

BGL = 76

caller was concerned neighbors that hadn't heard from pt for a day or two.
unknown if pt is normally living independently or not.

unknown hx.

meds = hypertension medication bottle on kitchen counter
[remember, pt located in bedroom]

this crew is als... but medic wants emt-b to assess and decide on course of action [to the best of his scope] -- besides just turning it over to als.

***FORGOT TO MENTION PT IS APPROX 350 LBS. - SRY LOL***
 

BossyCow

Forum Deputy Chief
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Is it bright red blood or coffee ground emesis?
 

Topher38

Forum Lieutenant
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Is it bright red blood or coffee ground emesis?

How about AVPU?

Is this patient responsive at all?


A Oxygen via nonrebreather 15L / min
-N.P.A. (12 and shallow)
B Hows the breathing? (any snoring? gurgling?)
-Suction. If the pt vomited.
C Any Obvious bleeding on the pt?

What does the patients mouth smell like? (any vomit around the corners?) Funny sounding, i know but that vomit may not be from this paticular episode.

Skin is pale
pulse is still 72 thready
B/p ???? What is it with ascultation?
Respirations 12
Pupils?

ALS (moniter)
 

gcfd_rez31

Forum Probie
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pt is slightly responsive.

pt is having snoring resperations.

no obvious bleeding. just the blood in vomit.

pt's mouth smells like vomit.
 

JPINFV

Gadfly
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Examine mouth for anything less to suction and suction PRN.

Temp?
Edema?
JVD?
Indications of hx of EtOH abuse?
Color/consistency of vomit?
Incontinence?
Name of HTN medication?
 
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certguy

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Are there any indicators of CVA or fall ? Something nobody's mentioned also is that a pt. down for extended periods on a tile floor in there own urine/feces will most probably be hypothermic also in addtion to the other problems . What is the volume of blood loss ?
 

sabbymedic

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Ok well now you have to hold the loose bowel feeling in and get to work. Activate any and all resouses available including air ambulance. If scene is secured get more resources out there to act as triage set up. Two or three individuals need to stay with this victim the rest need to go to a secure scene to set up triage as mentioned above. ABC's good. Prior to PHTLS survey someone should be doing very careful C- spine maintenance. Next PHTLS survey to look for any life threatening wounds and control any and all serious bleeds. O2 Blanket and vitals if you have time, remember this pt needs a surgeon. If you are not too worried about ICP elevate the legs to maintain BP or if you are able to establish IV start large bore IV with an infusion of 20ml/Kg 0.9% NACL remember to evaluate lung sounds prior to fluid administration and check after every 250cc infusion. This pt also needs to be boarded due to gun shots and possible spinal injuries. If this pt is able to be transported directed to a trauma facility right away by land transport and waiting for air evac would take too long send by land. This pt would be part of your triage system that will be taking place at the original scene something to remember as all your resources will be heading that way so you will need to notify dispatch of this. Can't really think of much else other than monitor vitals every 5 min if No IV then use Mast Trousers if available our service does not use them we have to elevate legs, oh yeah drive fast.
 

JPINFV

Gadfly
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Just wondering, does anyone have any evidence that trendelenburg actually works? The closest I've seen to validation of that position is a "it might have increased blood pressure in 1 subject with no increase of cardiac output." Besides that, every single study failed to come close to rejecting the null hypothesis.
 

skyemt

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Just wondering, does anyone have any evidence that trendelenburg actually works? The closest I've seen to validation of that position is a "it might have increased blood pressure in 1 subject with no increase of cardiac output." Besides that, every single study failed to come close to rejecting the null hypothesis.

i attended a class at the JEMS conference that referenced this... they cited a study (don't know which one), the results were only a minimal difference in preload, and no real measurable increase in CO.

one of those things that's in all the protocols (at least in NY), but i, like you, have not been able to find any reference to a real improvement with this position.
 

sabbymedic

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Ok. There may not be a big increase in cardiac output but if I read correctly the pt has a BP of 80 palp. The BLS patient care standards says to use this position to help eleviate the effects of hypotension which in this case if you do not have IV access at least you are doing something other than watching the pt die. That was the point I was trying to make doing something is better than nothing.
 

JPINFV

Gadfly
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Doing something with no scienfitically measurable effect is better than doing nothing?
 

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