emtbill
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She could be faking buy really who cares. Whether she is or not is not going to affect your care. The change in consciousness could be from the head trauma, but since she is already immobilized there's nothing to do about increased ICP unless you're a flight service with mannitol, or maybe you could RSI (premedicating with lidocaine) to put the patient in a drug induced coma to decrease further brain swelling, but that would be very aggressive and I would not do it, though some providers might. I would also be monitoring EtCO2 to ensure adequate ventilation and changes in respiratory rate and depth but other than that this is a supportive care patient. I would have also started an IV. With this type of altered patient where many things could be going on there is nothing wrong or excessive with starting a routing 18 or 20 gague saline lock in their AC as some are saying.
On patients playing possum in general: If your assessment of the patient returns normal, including 12 lead, SpO2, FSBGL, neuro exam, etc, don't get too caviler thinking this is a drug overdose and trying to fix it with a bolus of narcan. As vent said this is done far too often. If the patient is unresponsive and is perfusing (SpO2=100%) and ventilating (EtCO2=35mmHg rather than 70mmHg) adequately, but is breathing 6 times a minute, I put the patient in recovery position and write "patient rested comfortably throughout transport" on my run report. Breathing and ventilation are commonly confused and if you understand the difference between the two it's a major clinical upgrade. Narcan does not always have a wide safety margin in a "coma cocktail" as many are taught, and can produce (but not limited to) grand mal seizures in the chronic opiate users. This is why ambulances generally do not carry romazicon, because it will get used far too often and will leave the seizing patient untreatable.
On patient you suspect are seizing for a benzo bolus: again, the best way to differentiate this is with EtCO2. If the patient is having a legitimate, sustained grand mal seizure (which is the only type you should be treating in the field), then the patient's medulla oblongata will also be affected, and the capnogram will show apnea. I have several strips of an EKG showing noise from the patient's "seizing", but the capnogram shows a normal waveform. They'll get tired of shaking in a minute and stop.
If you don't have EtCO2 nasal cannulas, get some. Steal from the hospital if you have to. It's worth your time to learn to read the waveforms.
On patients playing possum in general: If your assessment of the patient returns normal, including 12 lead, SpO2, FSBGL, neuro exam, etc, don't get too caviler thinking this is a drug overdose and trying to fix it with a bolus of narcan. As vent said this is done far too often. If the patient is unresponsive and is perfusing (SpO2=100%) and ventilating (EtCO2=35mmHg rather than 70mmHg) adequately, but is breathing 6 times a minute, I put the patient in recovery position and write "patient rested comfortably throughout transport" on my run report. Breathing and ventilation are commonly confused and if you understand the difference between the two it's a major clinical upgrade. Narcan does not always have a wide safety margin in a "coma cocktail" as many are taught, and can produce (but not limited to) grand mal seizures in the chronic opiate users. This is why ambulances generally do not carry romazicon, because it will get used far too often and will leave the seizing patient untreatable.
On patient you suspect are seizing for a benzo bolus: again, the best way to differentiate this is with EtCO2. If the patient is having a legitimate, sustained grand mal seizure (which is the only type you should be treating in the field), then the patient's medulla oblongata will also be affected, and the capnogram will show apnea. I have several strips of an EKG showing noise from the patient's "seizing", but the capnogram shows a normal waveform. They'll get tired of shaking in a minute and stop.
If you don't have EtCO2 nasal cannulas, get some. Steal from the hospital if you have to. It's worth your time to learn to read the waveforms.