Scenario time.

EMR06

EMR06

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The scene: you notice the house is fairly dirty but safe to proceed.
bsi procedures taken:gloves,the usual
mother says her daughter is 16 y/o and diabetic
She had a fight with her boyfriend about a half an hour ago.meds missing meds: 6 tablets of propranol 80mg.amitripyline 50 mg. 2 500mg of acephetamine. and to top it off she washed it down with 2 bottles of beer. she slurs and tells you she is nausea'd and has not vomited. Last meal was 4 hours ago. She refuses to tell you when she last took or insulin.

p:96 and full, bp:100/70 rr:14 skin is warm,dry.


what will you do?
 
"C'mon, we're taking you to the hospital."

o2, some glucose paste, check vitals again and transport.

that's the first thing that comes to mind here. She's gobbled down meds for hypertension, depression, and some painkillers. I'd imagine that 480mg of propranol (for hypertension) could cause an unsafe drop in blood pressure. Transport times around here are > 15 minutes. Might take that long to dig out & administer the activated charcoal.
 
Contact online medical control
Inform them of the patients status, vitals etc
do a blood test for sugar.let control know what the results were. go from there. administer glucose or not. activated charcoal I would administer 15-25 mg. Aware of the possibility of vomitting and v-fib. update control with vitals. admit to emerg.
 
Who, me? or someone else? :P It's more of a 'forum' than a 'discussion' - and besides, I was off getting lunch.

We can't do glucose sticks here, that's why I left off "check glucose level." :|
 
I would check a blood sugar if she will let me. Monitor vitals to watch for a drop in B/P. Call for medical direction to administer Activated Charcoal, or if they want to have glucose administered. And of course I'm going to treat with diseal. Most of the time our transport time is about at 15 min, of course that depends on Location.
 
Hold off on that Glucose...

Since it's BLS.. I'll try to contain myself.

Collect the med bottles, or at least write them down, note when they were filled and the dosage. O2 12 by NRB. Transport. Med Command>Poison Control for Charcoal. Get a sick bag ready, just in case, point head toward rookie. Get your aspirator set up, again, just in case. Maintain airway, use a nasal if she becomes unconscious, bag if the resps are shallow, labored or noisy.
Keep an eye on the BP, especially with a propranolol and amitriptyline OD. That's an HBP med and depression med, both can cause hypotension. Raise the feet if it goes to 90 systolic, plan ahead. The combination of the two, in high dose, can cause cardiac arrest really quickly.

Call ALS. In this case, it would be better to treat the diabetic problem via IV. You don't want her to aspirate the glucose. That will be the least of her problems.
 
Do her symptoms really call for oral glucose? She is diabetic, but she also popped a good amount of pills and mixed it with alcohol. I dont see how that can be grounds to administer oral glucose, seemingly her vitals are well within normal range.
 
Gents82 said:
Do her symptoms really call for oral glucose? She is diabetic, but she also popped a good amount of pills and mixed it with alcohol. I dont see how that can be grounds to administer oral glucose, seemingly her vitals are well within normal range.
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I'd say go for the glucose because a)it won't kill her and b)the ER folks might say "you turkey, why didn't you give the diabetic some glucose!!" anyway. ;)

But for anyone who's gobbled down random pills like that, I'd take them in.
 
Doctor I know says this:

"Amitriptylline..tricyclic antidepressant in high doses it disrupts potassium uptake and stops your heart."

:D
 
Umm.... MEDIC!!!!!.... get an ALS intercept rolling, get on the phone with command / poison control - at the very least, get the ED ready to treat this C-F. Patient should probably get activted charcoal (yay). Make sure to have some large red bags ready for emisis, and try to be quick on getting to the ED.

As for glucose... check with the doc. Probably not a bad idea if pt. is maintaining her airway, but who knows for how long.

You can always ask Mom to check pt's blood sugar (you aren't breaking protocols, that way) if sugar is high, don't give glucose, if borderline or low, give glucose.


Also, if the glucose DOES work, the patient is going to be MORE unhappy to go to the hospital, so getting a second BLS rig / FD / or extra PD rolling for a manpower assist with restraint if needed might not be a bad idea.
 
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w/ the beta blocker on board she is not going to present as your run of the mill hypoglycemic. She will likely not be diaphoretic or tachycardic and if her MS drops due to low BS it will probably happen rather fast. I am not big on BGL's on non-tachy/altered, dry pt's but I think this is a case where you might need to rethink that one. If ya can, check her BGL, if not, throw her an amp of D-50 down the IV. As for the rest, I would way call ALS. The TCA/beta-blockade is a bad thing. Oh yea, what was her mental status?
 
i work on an als-rig so i would get a blood sugar reading prior to administering any glucose and my medic would want a line so he can give her meds via i.v.
i agree with o2, slap her on the ekg, and forget the little emesis bag, i'd cut a hole in a pillowcase and get that around her neck. not sure about the charcoal i admit, considering the mess it makes on the way back up...
we have a 30 minute transport time (the price you pay for living in such a beautiful area!)

since this would be an als call i'd be relegated to driving which is nice if you have a medic who wants to point the vomit spewing towards the "rookie"...lol of course if there is an irritating young fireperson that wants to ride along who am i to say BEWARE? heh heh

oh and definetely make mom drive in with anyone else but us!

kate
 
Be careful with oral glucose. This patient could go from conscious to comatose real quick and that brings about a large chance of aspiration. It doesn't sound like this is a blood glucose related incident, though it would be good to keep an eye on it if you can because the rumor is ETOH lowers blood glucose.
 
i_drive_code3 said:
i work on an als-rig so i would get a blood sugar reading prior to administering any glucose and my medic would want a line so he can give her meds via i.v.
i agree with o2, slap her on the ekg, and forget the little emesis bag, i'd cut a hole in a pillowcase and get that around her neck. not sure about the charcoal i admit, considering the mess it makes on the way back up...
we have a 30 minute transport time (the price you pay for living in such a beautiful area!)

since this would be an als call i'd be relegated to driving which is nice if you have a medic who wants to point the vomit spewing towards the "rookie"...lol of course if there is an irritating young fireperson that wants to ride along who am i to say BEWARE? heh heh

oh and definetely make mom drive in with anyone else but us!

kate
Click to expand...


A pillow case??? :glare: That would be like using a paper bag as a canteen.
 
TTLWHKR said:
A pillow case??? :glare: That would be like using a paper bag as a canteen.
Click to expand...

hey don't glare at me :wacko: silly medic our pillowcases are tyvek(x?) lined and they work wonderfully for those voracious vomiters!

kate
 
We do the same thing with the large red biohazard bags. We also use those wooden needle point hoops to hold the bags open.
 
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