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Crashing airway patient

Discussion in 'Scenarios' started by Rialaigh, Jan 2, 2017.

  1. Rialaigh

    Rialaigh Forum Asst. Chief

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    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...
     
  2. NomadicMedic

    NomadicMedic formerly DEmedic

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    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.
     
    FLMedic311 and FireWA1 like this.
  3. StCEMT

    StCEMT Forum Deputy Chief

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    Everything DE said...
     
  4. NomadicMedic

    NomadicMedic formerly DEmedic

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    I go on this exact call once a week. Southern Georgia = land of sketchy trailer parks.
     
    STXmedic likes this.
  5. StCEMT

    StCEMT Forum Deputy Chief

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    How long did it take you to meet a Joe Dirt look alike?
     
  6. NomadicMedic

    NomadicMedic formerly DEmedic

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    First week. No joke.
     
    CALEMT, VentMonkey and StCEMT like this.
  7. StCEMT

    StCEMT Forum Deputy Chief

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    That is awesome. I really hope he had a Skynryrd shirt to go with.
     
    VentMonkey likes this.
  8. cprted

    cprted Forum Captain

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    DE's post + Lung sounds? Respiratory pattern?

    When did this start? Sudden onset or gradually getting worse? Any associated pain (chest or otherwise)?
     
  9. FireWA1

    FireWA1 Has no idea what I'm doing.

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    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.
     
  10. NomadicMedic

    NomadicMedic formerly DEmedic

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    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.
     
    TRSpeed, Summit, captaindepth and 3 others like this.
  11. VentMonkey

    VentMonkey Crackpot Premium Member

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    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?
     
  12. VentMonkey

    VentMonkey Crackpot Premium Member

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    Bah! Ya' beat me to the punch:eek:...
     
  13. NomadicMedic

    NomadicMedic formerly DEmedic

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    ...Let's see what the OP has planned for this one.
     
    VentMonkey likes this.
  14. Handsome Robb

    Handsome Robb Youngin' Premium Member

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    My vote is to crich.


    Sent from my iPhone using Tapatalk
     
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  15. StCEMT

    StCEMT Forum Deputy Chief

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    Like this?
    [​IMG]
     
    FireWA1 likes this.
  16. VentMonkey

    VentMonkey Crackpot Premium Member

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    IMG_0120.JPG
     
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  17. FireWA1

    FireWA1 Has no idea what I'm doing.

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    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.
     
    TransportJockey likes this.
  18. FireWA1

    FireWA1 Has no idea what I'm doing.

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    Use a micro drip for peds!
     
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  19. DrParasite

    DrParasite The fire extinguisher is not just for show

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    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.
     
  20. ERDoc

    ERDoc Forum Asst. Chief

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    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.
     
    NomadicMedic likes this.

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