Epi-do
I see dead people
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The medical director came in and talked to my medic class today, at the end of our PHTLS class. Apparently, he failed all of us on our oral boards. I walked out knowing that there were things I could have done better, but over all thought I had done pretty well. His big issue, he said was that we weren't thinking outside the box. (This was after being told that he wasn't trying to trick us, or anything like that.) He drew that conclusion from the fact that we all treated the patient in our first scenario the same way, and we all missed something really big.
The scenario was as follows. You are called to a school for difficulty breathing. You arrive to find a 13yo male in the nurses office, blue, guppy breathing, covered in hives and with angioedema. He is barely able to talk 1-2 words at a time. The story is that he was given a cookie that looked like it was a sugar cookie, so he took a bite of it. Turned out it was a peanut butter cookie, and he has a severe peanut allergy. He immediately spits the cookie out of his mouth and runs to the nurses office, where you now find him. No sooner than you begin to treat him, he goes unresponsive. I can't remember what the vitals were exacty, but he is tachycardic, and hypotensive. Bilateral breath sounds were pretty much non-existant to begin with, and continue to diminish as time goes on. What little bit you can hear is equal bilaterally. He is getting more difficult to bag at time goes on. Depending upon how we treated the patient determined if he eventually coded or not.
Initially, the medical director said we all did great. We treated the anaphylactic shock appropriately, administering epi, securing the airway, administering albuterol and benadryl. Personally, I thought the kid was circling the drain and that I just wasn't making any headway with the anaphylaxis. I had gotten a tube, and had given all the epi and benadryl I could give. I started repeating the albuterol nebs, and was told that it very minimally improved breathsounds with each 5 mg treatment. He was still hard to bag, hypotensive, and tachycardic, and overall he kept getting worse. He had no tracheal deviation or JVD. I got him to the hospital, and he was pretty much sucking mud. I was at a loss for what else I could have done for this kid.
Turns out, the kid had bilateral tension pneumos caused by the EMT (due to overzealous ventilations) and needed to be decompressed. Once in the ER, they did do bilateral needle decompressions and also placed bilateral chest tubes. He eventually made a full recovery. (Yes, the scenario was an actual patient that was seen in the hospital ER and then admitted to Peds ICU.)
My entire class is really frustrated, and feels as if we were set up. I understand that part of this job is learning to think outside the box, but we are all still putting things together and trying to make sure we know what is inside the box. Is this something we should have picked up on?
The scenario was as follows. You are called to a school for difficulty breathing. You arrive to find a 13yo male in the nurses office, blue, guppy breathing, covered in hives and with angioedema. He is barely able to talk 1-2 words at a time. The story is that he was given a cookie that looked like it was a sugar cookie, so he took a bite of it. Turned out it was a peanut butter cookie, and he has a severe peanut allergy. He immediately spits the cookie out of his mouth and runs to the nurses office, where you now find him. No sooner than you begin to treat him, he goes unresponsive. I can't remember what the vitals were exacty, but he is tachycardic, and hypotensive. Bilateral breath sounds were pretty much non-existant to begin with, and continue to diminish as time goes on. What little bit you can hear is equal bilaterally. He is getting more difficult to bag at time goes on. Depending upon how we treated the patient determined if he eventually coded or not.
Initially, the medical director said we all did great. We treated the anaphylactic shock appropriately, administering epi, securing the airway, administering albuterol and benadryl. Personally, I thought the kid was circling the drain and that I just wasn't making any headway with the anaphylaxis. I had gotten a tube, and had given all the epi and benadryl I could give. I started repeating the albuterol nebs, and was told that it very minimally improved breathsounds with each 5 mg treatment. He was still hard to bag, hypotensive, and tachycardic, and overall he kept getting worse. He had no tracheal deviation or JVD. I got him to the hospital, and he was pretty much sucking mud. I was at a loss for what else I could have done for this kid.
Turns out, the kid had bilateral tension pneumos caused by the EMT (due to overzealous ventilations) and needed to be decompressed. Once in the ER, they did do bilateral needle decompressions and also placed bilateral chest tubes. He eventually made a full recovery. (Yes, the scenario was an actual patient that was seen in the hospital ER and then admitted to Peds ICU.)
My entire class is really frustrated, and feels as if we were set up. I understand that part of this job is learning to think outside the box, but we are all still putting things together and trying to make sure we know what is inside the box. Is this something we should have picked up on?
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