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I've temporarily removed a thread that I recently created that would totally give this away, so if you already read that maybe don't spoil this immediately.
Your ALS ambulance and two person BLS fire unit are dispatched on a 31D2 Subject Unconscious--Severe Respiratory Distress, patient is a 16 year old female. You are responding to a residence that is about 15 minutes away, and while enroute dispatch advises that the patient is "foaming at the mouth." You and fire arrive on scene at the same time, where you are met by the father who beckons you into a holiday rental home that is well kept and rather pricey looking. He brings you into the ground level bedroom where you find your patient supine in bed where other, borderline hysterical family members are trying to wake her up.
Your initial assessment reveals the following: Pt is breathing at approximately 30 times per minute with normal depth and occasional snoring respirations. Heart rate of 130.
Mental Status: Pt responsive to painful stimuli only, which causes her to open her eyes, no verbal response. Skin: Well-perfused, hot, and dry. HEENT: Significant amount of saliva is present in the oropharynx, pt appears "almost trismused" (2 cm gap between teeth, jaw is fixed). Pupils open during painful stimuli to reveal that they are somewhat dilated, equal, and reactive. Pt has an obvious leftward gaze with occasional nystagmic movements through all fields. Chest: Equal rise and fall bilaterally with clear lung sounds throughout. Abdomen: Soft, palpation does not elicit pain responsive. CTLS: Unremarkable. Pelvis: No incontinence or other abnormalities noted. Extremities: Decorticate posturing noted with both feet and wrists. No signs of trauma noted anywhere on patient.
Vitals: BP: 110/70, HR: 130 Sinus Tach, RR: 30, SpO2: 94% RA, EtCO2: 25, BGL: 81.
Family states patient does not take any medications aside from Emergen-C. Patient has no diagnosed history, though family stated that patient has had frequent nosebleeds over the last few weeks. No drug or food allergies. They stated that patient flew in from Arkansas yesterday, which is a 6000 foot change in elevation and twoish hour flight. Once she arrived pt went sledding but did not appear to suffer any trauma during that. No one in the house takes prescription medications. Patient went to bed at nine last night, and mom came in at 730 this morning to wake her up, pt smiled then went back to sleep. At nine they were unable to wake her and called 911.
So what are you going to do? What are your differentials? There is a six bed critical access ED 15 minutes away and a Level II, pediatric accepting facility 1 hour by ground. Flight is not available due to low cloud cover and occasional snow showers.
Your ALS ambulance and two person BLS fire unit are dispatched on a 31D2 Subject Unconscious--Severe Respiratory Distress, patient is a 16 year old female. You are responding to a residence that is about 15 minutes away, and while enroute dispatch advises that the patient is "foaming at the mouth." You and fire arrive on scene at the same time, where you are met by the father who beckons you into a holiday rental home that is well kept and rather pricey looking. He brings you into the ground level bedroom where you find your patient supine in bed where other, borderline hysterical family members are trying to wake her up.
Your initial assessment reveals the following: Pt is breathing at approximately 30 times per minute with normal depth and occasional snoring respirations. Heart rate of 130.
Mental Status: Pt responsive to painful stimuli only, which causes her to open her eyes, no verbal response. Skin: Well-perfused, hot, and dry. HEENT: Significant amount of saliva is present in the oropharynx, pt appears "almost trismused" (2 cm gap between teeth, jaw is fixed). Pupils open during painful stimuli to reveal that they are somewhat dilated, equal, and reactive. Pt has an obvious leftward gaze with occasional nystagmic movements through all fields. Chest: Equal rise and fall bilaterally with clear lung sounds throughout. Abdomen: Soft, palpation does not elicit pain responsive. CTLS: Unremarkable. Pelvis: No incontinence or other abnormalities noted. Extremities: Decorticate posturing noted with both feet and wrists. No signs of trauma noted anywhere on patient.
Vitals: BP: 110/70, HR: 130 Sinus Tach, RR: 30, SpO2: 94% RA, EtCO2: 25, BGL: 81.
Family states patient does not take any medications aside from Emergen-C. Patient has no diagnosed history, though family stated that patient has had frequent nosebleeds over the last few weeks. No drug or food allergies. They stated that patient flew in from Arkansas yesterday, which is a 6000 foot change in elevation and twoish hour flight. Once she arrived pt went sledding but did not appear to suffer any trauma during that. No one in the house takes prescription medications. Patient went to bed at nine last night, and mom came in at 730 this morning to wake her up, pt smiled then went back to sleep. At nine they were unable to wake her and called 911.
So what are you going to do? What are your differentials? There is a six bed critical access ED 15 minutes away and a Level II, pediatric accepting facility 1 hour by ground. Flight is not available due to low cloud cover and occasional snow showers.
