Treat My Pt, Version 2.0

[Grady_emt]

44 yof called in by APD unit as Uncon/unresp. 4 minutes after disp, upon our arrival found lying on sidewalk with purse as pillow apparently asleep. Officer advises that he tried to wake her up after driving by and seeing her lying on the sidewalk.

Moderate sternal rub awakens her to an appant stupor with slurred speach, and unsteady gait initially. After steadying her for a moment, she begins to become more coherant and steady on her feet, stating she just wants to walk home and go to sleep. After getting her in the truck, semi-fowlers on stretcher, V/s as follows pulse 102, BP 128/88, resp 18, Accu-check 146, SpO2 97%. Denies and ETOH or ANY drug abuse despite crack burns (none too fresh) on her hands. 12 lead Sinus, - ectopy. BLS transport, -INT, only monitor, pt quickly fell back asleep.

Short transport (<10 minutes) to major area hospital where ER triage finds vitals as follows pulse 46, BP 82/58, resp 16, SpO2 96%, accu-check 138 12 lead still sinus brady, - ectopy. Now much more sluggish to react, requiring a much stronger sternal rub to arouse, and quickly slips back again.

What ideas would do yall have, I talked to the attending and found out her condition, just seeing what you might have/have not done.
:beerchug:

 

[Ridryder911]

There are so many variables from the crack wearing off to using downers to contra-act the meth or even Sick Sinus Syndrome, to who knows what?

Since she is a suspected substance abuser, I might give a trial dosage of Narcan since she is becoming more somnolent and hemodynamically changes. Attach the fast patch, in case there is some increasing hemodynamics occurrences, but not treat the pressure or rate at this point. Rather, I would administer a bolus of fluid, and re-examine with more detail H & P (specifically the neuro). Of course maintain ABC's etc..

R/r 911

 

[triemal04]

Unless something out of the ordinary turned up on the physical (pinned pupils...traumatic injuries...track marks...dilated pupils...) probably not to much. I'd definetly have checked her sugar in the field though. Start a line, maybe give a little bit of fluids, but if her pressue stayed good and the rate came down a bit maybe not. Course if her pressue dropped into the 80 systolic range then yeah, she get's fluid and I'd be rechecking everything just in case.

What was the dx? OD?

 

[Grady_emt]

The second set of vitals we got in the field were consistent with what the first set was.

Dx was a mix of Amphetamine and benzo and other substances that had her body compensating for one, and then as soon as he had compensated, the other would kick in causing over compensation.

Thus the benzos made her go to sleep initially, when we woke her up, the amphetamines started up and kept her vitals up for a while, by the time we arrived at the er, her body had overcompensated for the amphetamines and had depressed her systems again causing the hypotension and bradycardia.

discharged after 2 days admitted.