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EMS Scenario
You are dispatched at 14:50 to a residential area for a report of a man down in the driveway. Dispatch says that a neighbor called this in and said that he has been laying there for approximately 30 minutes. It is a December day, light snow on ground with temps of 30 degrees.
Dispatch advices you to stage in area to wait for LEO to secure scene.
After scene is secured you are called on scene to 50 yr old male unresponsive with labored breathing laying on driveway by passanger side door of a mini van. Several empty and full beer cans are scattered about. LEO retreived female from house and is questioning her are you arrive.
Patient had vomited and has a knot on his head.
How would you handle this situation? Patient care? Ask any questions you may have and if possible I will answer them.
John
Dispatch advices you to stage in area to wait for LEO to secure scene.
After scene is secured you are called on scene to 50 yr old male unresponsive with labored breathing laying on driveway by passanger side door of a mini van. Several empty and full beer cans are scattered about. LEO retreived female from house and is questioning her are you arrive.
Patient had vomited and has a knot on his head.
How would you handle this situation? Patient care? Ask any questions you may have and if possible I will answer them.
John
Replies to This Discussion
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Permalink Reply by Dustin J. Millis on
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Write reports, get coffee, flirt with the hospital staff, clean the rig and drive by one of the quieter stations on the way back and lean on the airhorn...
HAHAHAHA, Damn Kali; were you spying on me last night????
And yeah, Kali pretty much covered this one to a T
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Permalink Reply by Cody W. Nelson on
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Did they ask you to stage because it looked like a domestic? I'm just curious.
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Permalink Reply by Station10Capt106 on
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they asked us to stage because a neighbor noticed them coming home. The guy got out and fell down and the woman just went into the house. They did not know the circumstances and probably assumed it was a domestic.
The woman said that he gets drunk all the time and was going to just leave him out there until he woke up. Problem was that hypothermia was starting to set in. He just had a hooded sweatshirt on and was laying on cold cement.
With his vomiting his airway was compromised and probably aspirated some. He was not responsive enough to clear his airway. He had a knot the size of an egg on his forehead from striking the ground.
John
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Permalink Reply by Ben Waller on
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Kali covered most of what I'd do, but I'd start with ensuring that the cops kept the wife and bystanders away in case this is a domestic or other assault.
Added detail to Kali's assessment and treatment would be...
My hypothermia protocol would include checking the patient's temperature with a temporal thermometer. If the patient is hypothermic, the first rule is to handle the patient gently. Rough handling of hypothermic patients can precipitate ventricular fibrillation.
I'd continue by completely removing the patient's clothing and doing a head-to-toe physical exam to rule out other visible/palpable injury.
Once the patient is unclothed, I'd add a 12-lead ECG to rule out a STEMI.
I'd continue further by wrapping him in warmed blankets, and applying insulated heat packs to the patient's armpits and groin with frequent checks to ensure that the heat packs are not causing a thermal injury. The rig's patient compartment would be kept as warm as I could get it.
If the patient has inadequate respirations, I'd ventilate him with a BVM.
Transport would be smooth, not fast, to prevent the v-fib problem mentioned earlier.
During transport, I'd monitor the patient for response to warmth, D50W if he was hypoglycemic, and Narcan. Most importantly, I'd continue to monitor the patient's airway, pulse oximetry, and heart rhythm and rate. If the patient remains unresponsive and I can't maintain his airway with BLS airways and suction, I'd intubate.
I'd also make sure that the airway was checked for tube placement prior to moving the patient to the E.D. bed, and was re-checked immediately thereafter to prove that it was still patent.
We have electronic PCRs, so my report would be keyboarded, not typed.
On the way out I'd check the protocol book in the E.D. physician's office to ensure that it has our latest protocol updates.
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Permalink Reply by Reg Mathis on
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I would guess his New Years Resolution would be to move to a place with no stairs!
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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god that was funny and brought back some really cool memories... did I catch the part where you do a accucheck / glucose check for blood sugar levels... maybe a little breath check to see if he was indeed a diabetic with the fruity odor to the breath... it's the history that may be undependable here depending upon the condition of the wife as well as the reality that alcohol and diabetes don't mix too well... depending on the wife and while your at it, maybe collect all the meds in the house to help put together some kind of medical history... but still Kali, the part about the airhorn... now that's EMS with style and a drive-by. funny stuff girl, :D CBz
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Permalink Reply by Jason Brooks on
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I think a trauma center/alert would be in order. A little Thiamine wouldn't hurt this fella either, especially due to the "he gets dunk all the time" history. A couple of warm IV's would be a nice touch too.
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The unintended benefit is all of that broken sheetrock - ingredients for the next Tincture of Drywall.
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Permalink Reply by Paul Montpetit on
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I would start out by assessing the A,B,C'c then proceed with primary assessment and full spinal immobilization...support airway, administer Oxygen 15 lpm via non-rebreather, if resp rate >24/minute would bag him..on a monitor(run a strip)..obtain IV access large bore(18 gauge)Normal saline at KVO rate....rapid transport and call for ALS if you aren't running ALS on your responding rig.....(I sort of assumed you were) Also you would want to treat for Hypothermia, he may need outside assistence in regaining body core temperature.... Personally I would suspect that someone saw the Tiger Woods story and tried to copy it......LOL....Paul
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Ralph...only problem I noted was she broke her left arm down on the back swing....but apparently still made good contact.....
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