Unconscious kid lying in a room

[Akulahawk]

Wouldn't incontinence be a possible indicator of a c-spine injury?

Yep and so would priapism

It could also be an indicator of head injury, too much beer on board and not enough room in the urinary bladder to contain it all... many things. Mostly non-traumatic causes.

EMT1A - much learning you must do. The scene itself often can tell you LOTS about the patient. Unconscious kid lying face down in a room just doesn't tell me much at all. Walk in and start observing the room. Where's the kid relative to other objects in the room? What does the parents, care providers, or any other witnesses tell you about the patient? Can you see the patient breathing?

These are things you can get answered as you walk up to the patient, before you even begin doing your physical assessment. With experience, you will learn what needs to be done and what doesn't.

BSI/Scene Safety I do always.
Airway/Breathing - checked as one step.
Circulation - checked quickly as well.
Consider the possibility of C-spine
Check Level of Consciousness.

This all takes just seconds... and I've been assessing since I got there using my eyes, nose, and ears.

Everything else that needs to be done is done as the situation warrants.

 

[Asclepius911]

You are, right don't listen to these guys, in paper and by text book always c-spine for an unwitness fall, again textbook is theoretic and nremt is as theoretic as book .. in the field we begin doing things in the most practical way that doesn't necessarily follow the book for instance .... in reality what would have happen in this situation, fire department would already have done opqrst rapid trauma and possibly if indicated have him on a backboard, all we will do is load him on our rig place o2 mask and go. For drunks, a medic doesn't really ride with us, but always make sure patient has a patent airway and prepare for suctioning aspiration is one of the highest killers for drunks.

 

[DesertMedic66]

You are, right don't listen to these guys, in paper and by text book always c-spine for an unwitness fall, again textbook is theoretic and nremt is as theoretic as book .. in the field we begin doing things in the most practical way that doesn't necessarily follow the book for instance .... in reality what would have happen in this situation, fire department would already have done opqrst rapid trauma and possibly if indicated have him on a backboard, all we will do is load him on our rig place o2 mask and go. For drunks, a medic doesn't really ride with us, but always make sure patient has a patent airway and prepare for suctioning aspiration is one of the highest killers for drunks.

If your in LA county and if you automatically assume fire is on scene first.

 

[Sandog]

You and your partner walk into a room and find a kid lying unconscious on the floor with empty beer bottles laying all around. The roommate is standing there as you enter.

My answer:

BSI
Scene Safety
Have my partner hold c-spine
Check airway
Drop an opa/npa if needed
Start bagging the patient on high flow o2 at 15lpm
Check circulation
Check for any apparent life threats
If circulation is good and no apparent life threats then c collar. If there is, treat the apparent life threats first
Have my partner ask questions, ie history, what happened, patient's medical history, etc
Backboard patient
Transport

So when you say kid, I assume we are talking more adolescent age. The beer thing and all. Ever seen a pissed off drunk dude with a NPA sticking halfway out his nose?

 

[bahnrokt]

So when you say kid, I assume we are talking more adolescent age. The beer thing and all. Ever seen a pissed off drunk dude with a NPA sticking halfway out his nose?

He's also half strapped to a backboard and has two guys chasing him with a BVM.

 

[Veneficus]

Yep and so would priapism

You cannot figure out if the patient has a potential c-spine injury or not and you are going to determine whether or not they have a painful erectile tissue dysfunction that lasted more than 4 hours without stimulation in a drunk teen?

Good luck with that...

I also wouldn't be overly impressed if somebody told me they use incontinence in a drunk person to determine spinal precaution need.

Just sayin...

Vene's rule of acute medicine #1. Never wrestle with a man holding a lightsaber.

 

[NYMedic828]

I noticed that the people asking this are paramedics. At the EMT level we're pretty much taught to c-spine instead of following some algorithm. I guess better safe than sorry.

Does not matter if you are an EMT, paramedic, RN or MD. You need to be competent at your level of care, and better yet above it. Being competent to a level above your own regardless of certification, is what I see as being safe over sorry.

EMS certification programs put WAY too much emphasis on fitting patients into groups instead of treating them as individuals. One day, treating someone like a chef and doing something because the recipe says to, will be wrong (it often is) and will catch up with you.

Also, incontinence in an unconscious/AMS person would probably lead me towards seizure/substance abuse (alcohol) before it would lead me to spinal injury...

 

[Doczilla]

You cannot figure out if the patient has a potential c-spine injury or not and you are going to determine whether or not they have a painful erectile tissue dysfunction that lasted more than 4 hours without stimulation in a drunk teen?

Good luck with that...

I also wouldn't be overly impressed if somebody told me they use incontinence in a drunk person to determine spinal precaution need.

Just sayin...

Vene's rule of acute medicine #1. Never wrestle with a man holding a lightsaber.

Plus, who can say it wasn't whiskey d*ck?

 

[Aidey]

I'm female, so I may have this wrong, but my understanding was that whiskey d!ck was a problem that presented... opposite... of priapism.

 

[Aidey]

Wouldn't incontinence be a possible indicator of a c-spine injury?

Yes, but you didn't answer my question.

 

[Doczilla]

(Hoping that you knew this was a joke...lol)

This condition refers to a state of limbo where you cant cross the finish line due to CNS depression, presumably due to an imbalance between prolactin and dopamine.

So you're not at "zero", and youre not at "ten." More like a steady "five".

 

[Aidey]

Oh, I was aware it was a joke, I just misunderstood the term to mean someone who was stuck at 0, lol.

 

[rwik123]

Oh, I was aware it was a joke, I just misunderstood the term to mean someone who was stuck at 0, lol.

I'm pretty sure that exactly what it is. The inability to achieve the desired result..

 

[Handsome Robb]

You are, right don't listen to these guys, in paper and by text book always c-spine for an unwitness fall, again textbook is theoretic and nremt is as theoretic as book .. in the field we begin doing things in the most practical way that doesn't necessarily follow the book for instance .... in reality what would have happen in this situation, fire department would already have done opqrst rapid trauma and possibly if indicated have him on a backboard, all we will do is load him on our rig place o2 mask and go. For drunks, a medic doesn't really ride with us, but always make sure patient has a patent airway and prepare for suctioning aspiration is one of the highest killers for drunks.

This is a prime example of why I would never want to find myself in an ambulance in LA.

You're medics turf unconscious people to BLS crews?

OP don't listen to us, none of us know what we are talking about

Asclepius, he asked for input and people gave it to him/her, why would you tell him to disregard information he/she asked for?

 

[Achilles]

I certainly would not have BB, unless it looked like there was obvious trauma where they jumped from a significant height I would call Al's so they could push narcan or I would transport depending on where they are and ED is.

 

[heatherabel3]

It almost sounds to me like your prepping for a practical exam. If I am right, and you are, you are gonna have a hard time. I have my practical in a few weeks and last night in class we ran a mock scenario for all the teams to get an idea of what to expect. Out of 6 teams, mine and one other team are the only ones who didn't kill the patient. You can't look at patient assessment as cookie cutter as you are. Yes, consider c-spine but you dont have to take it. Unconscious does not equal a BVM. Beer bottles doesn't always equal drunk passed out kid, maybe they were there from a party 2 nights ago and this kid has something else wrong and if you dont do a good assessment you won't know that. Like in our scenario last night, patient was in a fight MOI was a baseball bat. There was a hematoma on his forhead, a broken right wrist, and patient was having very rapid respirations. Every other team splinted the wrist and tried to bandage his head. We called for ALS, started bagging the patient in an attempt to bag him down, cut his clothes to reveal a bruised right rib cage. Evaluator called patient was getting hard to bag, we called probable pneumothorax packaged patient and handed off to ALS.

So my point is, don't get tunnel vision, don't get distracted, and you may not hit every block on the assessment sheet and thats ok.

 

[Handsome Robb]

I certainly would not have BB, unless it looked like there was obvious trauma where they jumped from a significant height I would call Al's so they could push narcan or I would transport depending on where they are and ED is.

Why are you jumping to narcan?

Naloxone is a drug. It has indications. We don't just push it blindly "just in case".

 

[Medic Tim]

I certainly would not have BB, unless it looked like there was obvious trauma where they jumped from a significant height I would call Al's so they could push narcan or I would transport depending on where they are and ED is.

How did you get opiate od out of the info provided. As rob said we don't give a drug for the sake of giving a drug. Even if it was an opiate od, if the pt is maintaining a patent airway and adequate oxygenation there is no need to give narcan. We do not give narcan to wake a pt up. We give it to restore/improve the pts respiratory effort.

I really hope the old coma cocktail is no longer used.......anywhere.

 

[bahnrokt]

I certainly would not have BB, unless it looked like there was obvious trauma where they jumped from a significant height I would call Al's so they could push narcan or I would transport depending on where they are and ED is.

Let's stick an epi pen in his neck. Maybe there was a bee in one of those bottles of Natty Ice he was downing.

 

[Aidey]

It almost sounds to me like your prepping for a practical exam. If I am right, and you are, you are gonna have a hard time. I have my practical in a few weeks and last night in class we ran a mock scenario for all the teams to get an idea of what to expect. Out of 6 teams, mine and one other team are the only ones who didn't kill the patient. You can't look at patient assessment as cookie cutter as you are. Yes, consider c-spine but you dont have to take it. Unconscious does not equal a BVM. Beer bottles doesn't always equal drunk passed out kid, maybe they were there from a party 2 nights ago and this kid has something else wrong and if you dont do a good assessment you won't know that. Like in our scenario last night, patient was in a fight MOI was a baseball bat. There was a hematoma on his forhead, a broken right wrist, and patient was having very rapid respirations. Every other team splinted the wrist and tried to bandage his head. We called for ALS, started bagging the patient in an attempt to bag him down, cut his clothes to reveal a bruised right rib cage. Evaluator called patient was getting hard to bag, we called probable pneumothorax packaged patient and handed off to ALS.

So my point is, don't get tunnel vision, don't get distracted, and you may not hit every block on the assessment sheet and thats ok.

Just because they did the wrong thing doesn't meant you did the right thing. Go ahead and try to "bag down" a conscious and alert pt with a pneumothroax. You'll cause more harm than good, although the harm may end up being caused to you when he starts throwing punches. Plus in this case the tachypnea is an appropriate response to the injury.