VentMonkey
Family Guy
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Pretty clear cut scenario, but would still like to hear everyone's thoughts, treatments, and/ or differentials; then I'll share mine.
You respond to the residence of a 40 y/o male found lying supine on the living room floor of a single story house. There's plenty of room to work where the patient is found, however, he's noted to be incontinent to urine, and smells as if he's been laying in his urine for a good amount of time by the time you arrive.
You're greeted by your local BLS fire department, who's captain briefs you. He informs you that the patient was found by family with an AMS, snoring respirations, but an intact gag; the patient would not tolerate a BLS airway with simple BVM ventilations, and an OPA.
Once you enter the house you find your male patient with extremely erractic respirations, on O2 @ 15 lpm NRB. A brief primary assessment reveals unequal pupils with the right pupil 2 mm's and fixed, the left pupil 4 mm's and fixed. The patient appears to be intermittently posturing, but no active/ prolonged seizure activity...yet. The patient's other V/S are as follows: BP- 240/120; HR-60-70 (NSR); RR-20-24 erratic (Biot's pattern), and again SPO2 remains well above 94% with good waveform pleth.
You note no obvious trauma, nor is any reported. Breath sounds appear CBL, SPO2 is @ 100% with supplemental O2 being given, and the patient's BGL is 160 mg/ dl.
While having your partner, and fire personnel package the patient for transport, and load him onto the gurney, you ask family and friends, who are all hovering over their loved one understandably concerned, for some further H/A/M.
They don't provide much more than he's fairly healthy, has no allergies that they are aware of, doesn't take any home medications, but they do admit that the patient has a history of substance abuse; specifically methamphetamine, and heroin. You see no fresh track marks, and the patient has workable vascular access, but somewhat valvular, that leads you to believe that the patient is, perhaps a recovering (attempting to) addict.
You are 2-3 minutes away from a level 2 trauma center with no clear cut, or established neurological capabilities 24/7, and about an additional 7 minutes away from another ED who sees (atraumatic) neurological cases much more frequently.
You don't have RSI in your bag today (I didn't this day
), but if you did, would you delay transport to secure said patient's airway?
Will you transport to the closer (trauma center) in hopes that there is neuro on-call today, or divert to the confirmed neuro center?
Are you going to given Narcan a try as a "rule out"?
What else can you guys think of, or would you like to know?
You respond to the residence of a 40 y/o male found lying supine on the living room floor of a single story house. There's plenty of room to work where the patient is found, however, he's noted to be incontinent to urine, and smells as if he's been laying in his urine for a good amount of time by the time you arrive.
You're greeted by your local BLS fire department, who's captain briefs you. He informs you that the patient was found by family with an AMS, snoring respirations, but an intact gag; the patient would not tolerate a BLS airway with simple BVM ventilations, and an OPA.
Once you enter the house you find your male patient with extremely erractic respirations, on O2 @ 15 lpm NRB. A brief primary assessment reveals unequal pupils with the right pupil 2 mm's and fixed, the left pupil 4 mm's and fixed. The patient appears to be intermittently posturing, but no active/ prolonged seizure activity...yet. The patient's other V/S are as follows: BP- 240/120; HR-60-70 (NSR); RR-20-24 erratic (Biot's pattern), and again SPO2 remains well above 94% with good waveform pleth.
You note no obvious trauma, nor is any reported. Breath sounds appear CBL, SPO2 is @ 100% with supplemental O2 being given, and the patient's BGL is 160 mg/ dl.
While having your partner, and fire personnel package the patient for transport, and load him onto the gurney, you ask family and friends, who are all hovering over their loved one understandably concerned, for some further H/A/M.
They don't provide much more than he's fairly healthy, has no allergies that they are aware of, doesn't take any home medications, but they do admit that the patient has a history of substance abuse; specifically methamphetamine, and heroin. You see no fresh track marks, and the patient has workable vascular access, but somewhat valvular, that leads you to believe that the patient is, perhaps a recovering (attempting to) addict.
You are 2-3 minutes away from a level 2 trauma center with no clear cut, or established neurological capabilities 24/7, and about an additional 7 minutes away from another ED who sees (atraumatic) neurological cases much more frequently.
You don't have RSI in your bag today (I didn't this day
), but if you did, would you delay transport to secure said patient's airway? Will you transport to the closer (trauma center) in hopes that there is neuro on-call today, or divert to the confirmed neuro center?
Are you going to given Narcan a try as a "rule out"?
What else can you guys think of, or would you like to know?
