Person down/unknown problem

StCEMT

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Called for person down, notes say 66 y/o female on the 6th floor of her apartment.

Pt supine on floor with spontaneous respirations, fire has an NPA and NRB at 10 going for what they say was low SpO2 and attempting to get full vitals. Currently only have a bgl which was 215.

Dried, bloody tinged vomit around the mouth, watery vomit with orange color around the head on the floor.

Had a few points I learned for future similar calls afterwards, just want to see what differentials y'all come up with and pick a few ideas from others experience. I'll answer what I can and will try to follow up to get a final diagnosis at the hospital tomorrow.
 

VentMonkey

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Suction out what I can while obtaining the following:
SPO2 with waveform pleth?
Breath sounds?
WOB?
Full set of vitals to include patients GCS.
Any obvious trauma/ need for spinal precautions?

Protect the airway, protect the airway, protect thee airway. Do BLS manuevers work? If not move to ALS manuevers post haste--> ETI.

Gain IV access, and go from there...
 

DrParasite

The fire extinguisher is not just for show
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is she conscious? you are dispatched for a person down, and it might just be a third party caller who say the woman fall.

pupils and physical assessment (particularly of head)?

who found her, how long has she been down, what's the story?
 

NomadicMedic

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Can't really do anything without vitals.
If you're putting her on the monitor, a 12 lead too.
Does she take any medication? Any history? Skin signs? the surroundings? Temp? What's the orange puke?

All the stuff, please.
 

VentMonkey

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Right, no differentials UFN @StCEMT. Lol, most veteran medics I know in reality don't throw them out without some sort of history, and/ or "story" told by family, friends, or the calling party.

Also, define "low SPO2". To me this screams aggressive airway management. Without knowing any further, and given the patients age, and a BGL WNL it's most likely an ICH. But please, ya' gotta elaborate or give up more info for others to bite...
 
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RocketMedic

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Sounds like time for paramagicking.
 

VentMonkey

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...Tang-orosis
 
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StCEMT

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I intentionally gave you my first 5 seconds just to see where y'all thoughts went.

-SpO2 Waveform was normal from what I remember. 92~% at 10LPM on her own with NPA. I believe they said initial was about 75-80%
-RFD said diminished ling sounds, but she was not taking nice hearty breaths. Tachypneic, a bit shallow.
- 96/68, pulse approx 110, no radial felt, carotid strong, 92%, 215 BGL,
-Very weak response to pain, otherwise no response.
-No obvious signs of trauma, head/neck felt alright, assuming a ground level fall.
-HTN and diabetes meds, otherwise nothing. No opiate found Rx's.
- last seen Friday, family tried to contact day before with no answer.
-orange meaning not bloody, normal looking vomit.
-surroundings is the bedroom, didn't actually get a temp, room was approx 70.

No luck getting to the hospital today by the way, won't be back til Friday.
 
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StCEMT

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Partner didn't remember what kind, but it was a confirmed head bleed.

What would be y'alls airway managment style of choice? Level 1 is 2 miles away. RSI? BLS? SGA?
 

VentMonkey

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Partner didn't remember what kind, but it was a confirmed head bleed.

What would be y'alls airway managment style of choice? Level 1 is 2 miles away. RSI? BLS? SGA?
Whatever keeps their SPO2 at or above 94%, prevents them from aspirating (good head positioning helps also), and gets them to definitive care safely, and efficiently.
 

VFlutter

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Managing Neuro critical care patients prehospital is tough since you are working in the blind and can't differentiate Ischemic vs hemorrhage. Granted this patient will be intubated before CT anyway. I would BLS to the hospital with that ETA. If you had to RSI i would use ketamine with that pressure however i would still anticipate hypotension.
 

RocketMedic

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Did you call Batman?
 
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StCEMT

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BLS was the end result. However I was also on the 6th floor of an apartment, so it wasn't as simple as scoop, run, be there in 10 total. I could have fully prepped (as much as would be possible) her for intubation on the way down from room/elevator/outside and intubated without significant time delay in the truck.
 

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