Forum Ride Along
Got dispatched to a residential address for 16yo with burns. On arrival, we find obese 16yo male patient in obvious distress - in the tripod position with a tachypnec respiratory rate. Not coughing, mildly tachycardic, oxygen saturation 100% - but complaint of 6-7 out of 10 chest pain, shortness of breath. Mallampati grade 4 airway, tachypnea seemed to be worsening. Friends showed us a video of the mechanism - kid took several giant hits of his lighter while depressing the button as if it was a vape, then lit it on fire. Proceeded to run around with obvious flames on video hitting himself in the face. Lung sounds were clear, BP hypertensive, pansystolic murmur noted on cardiac auscultation. WWYD??
Medic student riding along ended up getting an 18g IV in the hand. I had my EMT put him on 6lpm nasal cannula and 15lpm nasal cannula for preoxygenation. Loaded into the ambulance just to control the enviorment better, and I made the decision to attempt DSI. This was probably not the best method that could have been chosen as we are RSI capable, but I was concerned about the anticipated difficulty of the airway. Got medic student riding along to position him in head-tilt & jaw thrust, 2 person technique, I gave some ketamine and the EMT bagged @ 15lpm with nasal cannula still going at 6lpm. Our plan was 3 attempts to pass ETT via VL, if all failed we'd place iGel then. I failed first attempt, and the patient suddenly got very brady. Second attempt success, BP was quite hypotensive (86/palp per EMT) but went up with a fluid bolus. Patient was transported relatively uneventfully from there to our lvl 1 center / childrens hospital.