Emt approach

[Mariemt]

This is a rather simple scenario lol

I would have my partner hold c-spine.
Check ABC's

Breathing is slow, but if perfusion is adequate? I'd use a non-rebreather at 15lpm. You can never use too much oxygen.

After i would try and get a sample/history and determine wether c-spining this patient is necessary. After that I would pack'em and go. I would get vitals in the rig on the way. and re-asses for any changes.

As an EMT we are limited to what we can do. Just because someone is unconciousu doesnt make it an ALS call. From the scenario you've given? This patients vitals seem rather stable.


(Btw, for registry purpose's? You'd typically slide in an npa, and assisted ventilations)

But keep in mind. That can change at any given moment

yes, you can use too much oxygen. Titrate that stuff please!

And you really only need an NPA if his airway is being obstructed by soft tissue falling back. You can tell if the head tilt chin lift works. If that works, use an NPA if you can get chest rise and fall, you don't always need an NPA, this would be more assisted by giving an extra Brest I between rather than breathing for him.

Also he collapsed, didn't fall off anything, I wouldn't do c spine

And there is nothing stable about him. Call als!

 

[chaz90]

This is a rather simple scenario lol

I would have my partner hold c-spine.
Check ABC's

Breathing is slow, but if perfusion is adequate? I'd use a non-rebreather at 15lpm. You can never use too much oxygen.

After i would try and get a sample/history and determine wether c-spining this patient is necessary. After that I would pack'em and go. I would get vitals in the rig on the way. and re-asses for any changes.

As an EMT we are limited to what we can do. Just because someone is unconcious doesnt make it an ALS call. From the scenario you've given? This patients vitals seem rather stable.


(Btw, for registry purpose's? You'd typically slide in an npa, and assisted ventilations)

Unconscious patients are absolutely ALS. Level of responsiveness is one of your vital signs, and unresponsive is definitely out of the norm. Also, airway adjuncts aren't something to just use for the NR. I use some kind of airway adjunct every time I'm using a BVM. More airway protection is a good thing when you're using a temporary airway/ventilation fix like a BVM.

 

[Wheel]

This is a rather simple scenario lol

I would have my partner hold c-spine.
Check ABC's

Breathing is slow, but if perfusion is adequate? I'd use a non-rebreather at 15lpm. You can never use too much oxygen.

After i would try and get a sample/history and determine wether c-spining this patient is necessary. After that I would pack'em and go. I would get vitals in the rig on the way. and re-asses for any changes.

As an EMT we are limited to what we can do. Just because someone is unconcious doesnt make it an ALS call. From the scenario you've given? This patients vitals seem rather stable.


(Btw, for registry purpose's? You'd typically slide in an npa, and assisted ventilations)

But keep in mind. That can change at any given moment

What do you think is wrong with this child that it is just simple BLS? An unconscious child breathing eight times a minute when it was seemingly fine moments before is far from normal. What kind of pathology could cause this? What could ALS do that you can't? What else should you be checking on an unconscious person other than ABCs?

 

[Handsome Robb]

What else should you be checking on an unconscious person other than ABCs?

I'm guessing I'm not allowed to answer this question...

If you truly think this is a call BLS is capable of handling you're sadly mistaken my friend...

What can help guide our differential as to why this kid is unresponsive? I'm thinking of an acronym.

Schools have a file on every student that includes history, allergies and medications. Well at least here they do.

I agree with whoever said seizure. Definitely up there on my list.

 

[Carlos Danger]

I notice you make no mention of airway adjuncts. The textbook says unresponsive pt should be getting an OPA. Did you just forget, or would you not use OPA/NPA in this patient?

I've always kind of questioned this because what if you put an OPA in a pt like this, he wakes up and gags/vomits/aspirates? What if he wakes up enough to have a gag reflex, but not enough to pull out the OPA? It seems like an OPA has a good chance of making the situation much worse.

By definition, a patient who will accept an OPA needs one. Especially kids, because their tongue and soft tissue obstruct their airway easily, especially with PPV.

You probably lessen the likelihood of aspiration with an OPA in place, since it will allow you to use lower pressures and make gastric insufflation a little less likely. If the patient wakes up, they will gag for a few seconds and you will take the OPA out. No problem.

As an EMT we are limited to what we can do. Just because someone is unconcious doesnt make it an ALS call. From the scenario you've given? This patients vitals seem rather stable.

An 8 year old who is unresponsive and hypoventilating is anything but stable.

A RR of 8 in a pediatric patient is actually an ominous sign, and such a patient can decompensate very quickly if his airway and ventilation are not properly managed in a hurry.

 

[J B]

By definition, a patient who will accept an OPA needs one. Especially kids, because their tongue and soft tissue obstruct their airway easily, especially with PPV.

You probably lessen the likelihood of aspiration with an OPA in place, since it will allow you to use lower pressures and make gastric insufflation a little less likely. If the patient wakes up, they will gag for a few seconds and you will take the OPA out. No problem.



An 8 year old who is unresponsive and hypoventilating is anything but stable.

A RR of 8 in a pediatric patient is actually an ominous sign, and such a patient can decompensate very quickly if his airway and ventilation are not properly managed in a hurry.

I see, makes sense. Thanks.

 

[sisoybolso]

More information about this patient:
The school yard teacher noticed that he was running to catch the football and all of the sudden collapsed. She thought the tripped, but then realized something was terribly wrong when he did not get back up.

He and his fellow classmates were eating lunch in the cafeteria. However, he was not really hungry so he decided to sell his lunch to someone else.

SpO2 reading is 94%

Depth of breathing Shallow and irregular/some snoring resps

Blood Glucose? Not available until ALS Arrives


how does his skin look? cold and sweaty

Glasgow coma scale? 12
if you have anymore questions please ask.

 

[Mariemt]

OK, he is snoring so needs an adjunct. Could have mentioned this earlier. That alone might make his breathing better.
I'd try to add an extra breath in to bring his resp up a few.
.I'm not waiting for als. I am capable of a bgl. However I'm going to load and go and intercept als.

 

[mycrofft]

1. Assessment and vitals.
2. Does the pt fit any protocols?
YES: Use it
NO: ABC, support vitals, MAYBE cervical precautions.
3. Transport.

Ideas to entertain:
1. Postictal (needs off the hot ground and check for accidental injury).
2. Congenital cardiac or cerebrovascular abnormality (needs tincture of hospital ASAP).
3. Cryptic trauma (earlier blunt trauma to abdomen or head =>delayed downtime).Needs hospital (ultrasound, labs etc).
4. Illness (meningitis, etc etc etc). To hospital.
5. Heat illness: to hospital
6. Unknown: to hospital.

Do we see a pattern here?

BTW: what's with all the oxygen in the absence of clinical need? I know, your company has it in its protocols.

 

[Mariemt]

1. Assessment and vitals.
2. Does the pt fit any protocols?
YES: Use it
NO: ABC, support vitals, MAYBE cervical precautions.
3. Transport.

Ideas to entertain:
1. Postictal (needs off the hot ground and check for accidental injury).
2. Congenital cardiac or cerebrovascular abnormality (needs tincture of hospital ASAP).
3. Cryptic trauma (earlier blunt trauma to abdomen or head =>delayed downtime).Needs hospital (ultrasound, labs etc).
4. Illness (meningitis, etc etc etc). To hospital.
5. Heat illness: to hospital
6. Unknown: to hospital.

Do we see a pattern here?

BTW: what's with all the oxygen in the absence of clinical need? I know, your company has it in its protocols.

He is snoring and not breathing as much as he should. I haven't given the patient o2 yet just a few extra breaths. I would like to see his o2 around 96, but with his snoring, his o2 SATs will likely go down soon and the EMT should be ready for o2

 

[sisoybolso]

Patient fits in Pennsylvania the diabetic emergency protocol.
The idea of my posting here was to see how emts from other states would handle this call from the gate.
BSI, scene safety, number of patient, NOI, advise ALS, general impression, history taking all of that ( that's what I did at least)
he collapsed to the ground so he is not a trauma patient, plus we found out he did not eat lunch, was running like crazy.
Thank you so much in advance.
That was my first call and like I said I would like to know how you guys would take care of this situation and compare to what I did.

 

[Mariemt]

Assist vents first
load him into air conditioned ambulance. Get a bp and to hospital if a ways out do an als intercept
Body temp
Bgl
Need to know allergies. School know? How does his face, neck look? Lung sounds? Need an epi pen?
How did he look this morning at school? Hopefully teacher close by , have teacher ride along to give you last several hours of history
Als please

And here I sat with bgl in my first post. Yay me

 

[chaz90]

Patient fits in Pennsylvania the diabetic emergency protocol.
The idea of my posting here was to see how emts from other states would handle this call from the gate.
BSI, scene safety, number of patient, NOI, advise ALS, general impression, history taking all of that ( that's what I did at least)
he collapsed to the ground so he is not a trauma patient, plus we found out he did not eat lunch, was running like crazy.
Thank you so much in advance.
That was my first call and like I said I would like to know how you guys would take care of this situation and compare to what I did.

Where to begin?

What was the patient's BGL? Also, altered blood sugar (if indeed it is abnormal) doesn't always mean diabetes. Patients do not necessarily "fit into protocols" because some parts of their presentation falls into one category. If I'm following your line of thinking, you're using the fact that he's altered with a decreased appetite for one meal as justification for assuming he is experiencing a "diabetic emergency" (too broad of a category BTW).

Do some reading on the pathophysiology of Diabetes Mellitus Type I and II, and you will find neither disease leads to this kind of presentation as a matter of course. Type I Diabetes (suspected over type II due to age and history of this patient) is a problem with lack of insulin production leading to hyperglycemia. These patients aren't diagnosed just by suddenly passing out while running. A healthy 8 year old will not experience a drastic drop in blood sugar due to missing one meal and running around. Unless he accidentally shot up Grandpa's insulin at lunch, this really isn't a likely diagnosis.

 

[Mariemt]

Where to begin?

What was the patient's BGL? Also, altered blood sugar (if indeed it is abnormal) doesn't always mean diabetes. Patients do not necessarily "fit into protocols" because some parts of their presentation falls into one category. If I'm following your line of thinking, you're using the fact that he's altered with a decreased appetite for one meal as justification for assuming he is experiencing a "diabetic emergency" (too broad of a category BTW).

Do some reading on the pathophysiology of Diabetes Mellitus Type I and II, and you will find neither disease leads to this kind of presentation as a matter of course. Type I Diabetes (suspected over type II due to age and history of this patient) is a problem with lack of insulin production leading to hyperglycemia. These patients aren't diagnosed just by suddenly passing out while running. A healthy 8 year old will not experience a drastic drop in blood sugar due to missing one meal and running around. Unless he accidentally shot up Grandpa's insulin at lunch, this really isn't a likely diagnosis.

Dang I thought I read it was a diabetic emergency, not that he just followed protocol for one. Lol.

Yes, I would still have gotten a bgl just because I do with all unresponsive patients. I just do.
Yes, all type 1 I have seen are usually diagnosed after severe thirst, fast weight loss, excessive urination etc. Which goes hand in hand with hyperglycemia, not hypoglycemia.

What was this patients outcome?

 

[mycrofft]

Patient fits in Pennsylvania the diabetic emergency protocol.
The idea of my posting here was to see how emts from other states would handle this call from the gate.
BSI, scene safety, number of patient, NOI, advise ALS, general impression, history taking all of that ( that's what I did at least)
he collapsed to the ground so he is not a trauma patient, plus we found out he did not eat lunch, was running like crazy.
Thank you so much in advance.
That was my first call and like I said I would like to know how you guys would take care of this situation and compare to what I did.

Natasha Richardson will be happy to hear that falling down doesn't result in delayed fatality.

My experience with diabetics (worked jail's subacute section where we stabilized diabetics for six years) did not have them taking shallow resps.

h34r:

EDIT: I put that poorly. A fall can result in a delayed fatality, but what I meant to say was it can herald or be succeeded by a fatality (say, aneurysm rupture, closed abdominal injury, cerebrovascular event, all due to an earlier trauma but not complained about). Teachers seeing kid out and playing/running around does minimize that. Not a criticism, just an observation. Steady on!

 

[rmabrey]

I'll be in the minority here and say this patient needs c-spine.

Collapsed, unresponsive, while playing football. Yeah, Im not rolling into an ER with that story and no spinal precautions.

 

[Mariemt]

I'll be in the minority here and say this patient needs c-spine.

Collapsed, unresponsive, while playing football. Yeah, Im not rolling into an ER with that story and no spinal precautions.

I would had he been hit. But he wasn't just went down. Being 8, he didn't fall far.

 

[sisoybolso]

And here I sat with bgl in my first post. Yay me

Yes you did.

 

[sisoybolso]

Dang I thought I read it was a diabetic emergency, not that he just followed protocol for one. Lol.

Yes, I would still have gotten a bgl just because I do with all unresponsive patients. I just do.
Yes, all type 1 I have seen are usually diagnosed after severe thirst, fast weight loss, excessive urination etc. Which goes hand in hand with hyperglycemia, not hypoglycemia.

What was this patients outcome?

In Pennsylvania only ALS can measure bgl.
I am an EMT so that limits my actions

 

[sisoybolso]

I'll be in the minority here and say this patient needs c-spine.

Collapsed, unresponsive, while playing football. Yeah, Im not rolling into an ER with that story and no spinal precautions.

The school yard teacher saw him falling.