Dispatched to.............

[DT4EMS]

This is one I had a few years back.

You are dispatched at 0630 am for a report of “a man with blisters on his arm that are bursting”.

The call is in the projects. Upon your arrival, the scene is safe. There is a lot of family present. The house appears clean. A family member tells you the patient, her father is upstairs in bed.

You go upstairs and observe a clean bedroom there is a man lying in bed. He is alert and awake. He appears in no obvious distress. He has the blanket pulled up like he had been sleeping.

You begin to ask him the standard questions as your partner pulls the covers down to obtain the initial vital signs. As the covers go down you notice a little dirt on the bed and the patient has on street clothes. The patient is about a 60 y/o male. His V/S are all within normal limits (even according to the family).

Your secondary is unremarkable with the exception of what appears to be second-degree burns on the right arm. There are a few of the blisters that have appeared to have ruptured.

Where to you go from here?

 

[trauma1534]

This is one I had a few years back.

You are dispatched at 0630 am for a report of “a man with blisters on his arm that are bursting”.

The call is in the projects. Upon your arrival, the scene is safe. There is a lot of family present. The house appears clean. A family member tells you the patient, her father is upstairs in bed.

You go upstairs and observe a clean bedroom there is a man lying in bed. He is alert and awake. He appears in no obvious distress. He has the blanket pulled up like he had been sleeping.

You begin to ask him the standard questions as your partner pulls the covers down to obtain the initial vital signs. As the covers go down you notice a little dirt on the bed and the patient has on street clothes. The patient is about a 60 y/o male. His V/S are all within normal limits (even according to the family).

Your secondary is unremarkable with the exception of what appears to be second-degree burns on the right arm. There are a few of the blisters that have appeared to have ruptured.

Where to you go from here?

Need more Hx. What has he been doing? Obviously he does not fit this clean environment. If there are family members there, and he does not apear to be in obvious distress, then do they have vehicles in the yard? I would tell them to take him to the ER, or wait till the doctor's office opens. There is no reason to tie up a perfectly good ALS truck for this. Press hard, three copies, return to service, go back to quarters, report your truck off to the on coming shift, and go home, go to bed and live hapily ever after!

 

[DT4EMS]

There are tons of vehicles......... it's the projects. Simply asking a large gathering to take the person to the hosptial would put you and your partner at great risk of serious bodily injury in the projects.

It would also goet you rocked and bottled on the next call there.

You continue your good customer service and work toward gathering a history. Every question you ask hits a dead end. When you ask events prior the patient tells you "I wuz sleepin........ woked up an' here day is". Patient's family confims the patient has just been in bed.

Patient and family deny past medical history, medications or allergies.

You ask about bites, stings, thermal, chemical etc. all meet with "nope".

You load him up. Now is it ALS or BLS?

 

[trauma1534]

There are tons of vehicles......... it's the projects. Simply asking a large gathering to take the person to the hosptial would put you and your partner at great risk of serious bodily injury in the projects.

It would also goet you rocked and bottled on the next call there.

You continue your good customer service and work toward gathering a history. Every question you ask hits a dead end. When you ask events prior the patient tells you "I wuz sleepin........ woked up an' here day is". Patient's family confims the patient has just been in bed.

Patient and family deny past medical history, medications or allergies.

You ask about bites, stings, thermal, chemical etc. all meet with "nope".

You load him up. Now is it ALS or BLS?

First of all... where were the police?
Second of all... someone is not telling the whole story!!!
Thirdly, it's BLS!!! There is no altered LOC, vitals are good, etc etc.

Something tells me that you are leaving out something important to this story... there has to be more finding. Am I right? Was he druged? Something is just not adding up.

 

[Fedmedic]

Ask him if he wants to go to the hospital by EMS. If he does, clean and bandage arm, treat any other associated signs and symptoms accordingly with supportive care. If no other problems, vitals normal, take patient to triage at ER. Send large bill to insurance company with narrative explaining how patient did not need an ambulance. Then when insurance company denies bill,send it to the patient.

 

[yowzer]

Wearing street clothes to bed in a clean apartment is weird.

Try to get some cops on scene. It is in a housing project, after all.

Abuse that the patient doesn't want to report (At least not with all the abusers in earshot)? Get him alone. Get the number of his case worker and pass it on...

BLS, of course. Why would medics even be dispatched to it in the first place?

Hmm. What if it's not a burn, but an allergic reaction to something? Or poison ivy or the like? Have him take off his shirt and pants, look for more sites.

 

[trauma1534]

Ask him if he wants to go to the hospital by EMS. If he does, clean and bandage arm, treat any other associated signs and symptoms accordingly with supportive care. If no other problems, vitals normal, take patient to triage at ER. Send large bill to insurance company with narrative explaining how patient did not need an ambulance. Then when insurance company denies bill,send it to the patient.

Best tactfull idea yet! LOL
I still prefer to go back in service at that time of morning, report my truck off to the oncoming shift, and go home, get in the bed and sleep and sleep and sleep.. and when I'm tired of sleeping, I'll get up, and have my remote in my hand with my tv on, feet propped up on my recliner... just enjoying my day as if I had not even seen that patient that morning! But... that's just me!

 

[trauma1534]

Wearing street clothes to bed in a clean apartment is weird.

Try to get some cops on scene. It is in a housing project, after all.

Abuse that the patient doesn't want to report (At least not with all the abusers in earshot)? Get him alone. Get the number of his case worker and pass it on...

BLS, of course. Why would medics even be dispatched to it in the first place?

Hmm. What if it's not a burn, but an allergic reaction to something? Or poison ivy or the like? Have him take off his shirt and pants, look for more sites.

If this is an alergic reaction... with all in good normal limits, no airway compromise, PO Benadryl works wonders!!! He doesn't need us, he needs to go to the doc in the am and stop calling EMS when it is not needed!!!

 

[DT4EMS]

Back in 1992 I can assure you it was not routine for LEO to be dispatched to medical calls.

I am giving every ounce of info I could get. Western Palm Beach County (Belle Glade) back then was a huge area for several different types if illegals because of the sugar cane fields. You had to learn to be careful "how" you asked questions. Plus it didnt' matter.......... you transported to keep form getting trouble later.

All of our units were ALS.

I will tell you I transported him BLS. Wrapped with sterile dressings. The patient was polite en route. His story never changed.

Here's the kicker......... about 0830 hours I got a call from one of the ER docs. The patient coded thirty minutes after we got him there.

They worked him for a while but he died. This call was a new one on me an I have never seen one like it since.

 

[trauma1534]

Back in 1992 I can assure you it was not routine for LEO to be dispatched to medical calls.

I am giving every ounce of info I could get. Western Palm Beach County (Belle Glade) back then was a huge area for several different types if illegals because of the sugar cane fields. You had to learn to be careful "how" you asked questions. Plus it didnt' matter.......... you transported to keep form getting trouble later.

All of our units were ALS.

I will tell you I transported him BLS. Wrapped with sterile dressings. The patient was polite en route. His story never changed.

Here's the kicker......... about 0830 hours I got a call from one of the ER docs. The patient coded thirty minutes after we got him there.

They worked him for a while but he died. This call was a new one on me an I have never seen one like it since.

Not to sound cold hearted or sarcastic, I gues this was just one of those times when it was bizarly "his time to go". I still would have done the same for the patient as mentioned above, as it was clearly not an ALS call... and clearly something that could wate. You just never know. That's not meaning that I am a bad or cold hearted provider, it's just that I don't have time for BS. If there is a room full of people there and someone there has a vehicle, it is rediculess to transport a non-emergency if it can be gotten around. Or the alternative, they would have gotten a ride to the hospital and sat in triage. But, it is bazar. What did the doc say about it? Did he say what they found truely wrong with him?

 

[yowzer]

Here's the kicker......... about 0830 hours I got a call from one of the ER docs. The patient coded thirty minutes after we got him there.

They worked him for a while but he died. This call was a new one on me an I have never seen one like it since.

Could have been exposed to something toxic that burned him and soaked in?

 

[KEVD18]

lets not overlook the possibility the the chief complaint(burst blisters) may in fact have nothing at all to do with the cardiac arrest.....

i have no ideas on this one..

 

[DT4EMS]

When the doc called (who was actually our medical director) he asked "What do you think you had?"

I said "Well Doc, it's just how I encoded it........ what appeared to be second degree burns of unknown cause".

I asked the patient about thermal, chemical, radiation ........ I mean everything under the sun. There was nothing they would come up with. It is not uncommon for people to be poor historians with EMS and then tell them something different in the ER right in front of you .......... THAT YOU ALREADY ASKED THEM.......

Anyway........ the DOc didnt' know for sure until blood work came back.

The guy was a chronic alcoholic. It wasn't uncommon for him to be passed out for quite some time. The story the Doc got was the guy had passed out somewhere outside before coming home. I don't recall a time frame. The Doc figured the guy passed out and had his weight compressing his arm.

The blisters were from Gaseous Gangrene............ like I had that in medic school. I dealt with gangrene before but it was usually really noticable.....stunk to high heaven and looked rotten. This didn't.

Supposedly once the arm was open back to circulation it was only a matter of time.


This was one of the calls that make you go.............. dddddddddddaaaaaaaannnnnnngggggggggg!

 

[oldschoolmedic]

just a question... what color were the blisters? clear-fluid filled, greenish-pus filled, or black-fluid filled? I would have to gues the guy may have had one of two things to have died as quickly as he did. These may have been bubos not blisters in which case he had bubonic plague. regardless of how clean the place he was found, where had he been a few days ago. Second possibility would be gangrene, was there an attendant smell associated with these blisters? He would more than likely be super septic. Those are just the first things that come to my mind.

If the Giant blow this lead I will scream, listen for it.

 

[DT4EMS]

When the doc called (who was actually our medical director) he asked "What do you think you had?"

I said "Well Doc, it's just how I encoded it........ what appeared to be second degree burns of unknown cause".

I asked the patient about thermal, chemical, radiation ........ I mean everything under the sun. There was nothing they would come up with. It is not uncommon for people to be poor historians with EMS and then tell them something different in the ER right in front of you .......... THAT YOU ALREADY ASKED THEM.......

Anyway........ the DOc didnt' know for sure until blood work came back.

The guy was a chronic alcoholic. It wasn't uncommon for him to be passed out for quite some time. The story the Doc got was the guy had passed out somewhere outside before coming home. I don't recall a time frame. The Doc figured the guy passed out and had his weight compressing his arm.

The blisters were from Gaseous Gangrene............ like I had that in medic school. I dealt with gangrene before but it was usually really noticable.....stunk to high heaven and looked rotten. This didn't.

Supposedly once the arm was open back to circulation it was only a matter of time.


This was one of the calls that make you go.............. dddddddddddaaaaaaaannnnnnngggggggggg!

They were clear. No puss........ no smell.

 

[YYCmedic]

Did your pt have any chills or fever associated with his condition?

 

[YYCmedic]

Nevermind, I just missed that when I read your original post... "V/S normal"... i'm an idiot.

 

[CrazyRower]

Could have been exposed to something toxic that burned him and soaked in?

That was actually my thought as well, especially after someone brought up having lots of illegal residents in the area. maybe he was working with something that burned him (chemicals, etc) and didn't want to draw attention to the fact that he was working illegally. just a thought.

 

[Ridryder911]

Disregarding just because of "just blisters" well lead you right into court. I used to work in a burn center for several years, and sepsis is a quite common thing. Pseudomonas, staph, and other common bacteria is just a host problems..

I used to see more "gaseous gangrene", fortunately with antibiotics, hyperbaric chambers (HBO) these have drastically decreased in numbers. One needs to remember, that gaseous gangrene can also be harmful to the EMT as well.

I personally would had quickly loaded patient into my unit, with smiles and grins... then examined in a safer location or on the way. It is nice and a good theory to have LEO on the scene.. but, life is not always like that.

What are one going to do meanwhile you are in a potential dangerous scene.. aggravate them more? Street sense and using good common sense is the best thing sometimes...

R/r 911

 

[Pablo the Pirate]

Here's the kicker......... about 0830 hours I got a call from one of the ER docs. The patient coded thirty minutes after we got him there.

They worked him for a while but he died. This call was a new one on me an I have never seen one like it since.

obviously if he coded 30 min later this was an ALS run. regardless of how good of a historian this guy was you knew you were missing something important right from the begining. and since the thought of chemical burns came up right away you have to remember how caustic some chemicals can be and you are just seeing the "minimal" damage on the outside not nessicarily the nasty stuff goin on on the inside. and its better to be safe and transport ALS to the hosp. doing all you can and find out it was nothing than to have had him sign off or not do anything for him and face a law suit. personally id have taken him in quick and quiet ALS. just my $0.02