- Joined
- Apr 5, 2008
- Messages
- 431
- Reaction score
- 8
This one isn't as interesting or puzzling as Paseo's, but hopefully this will encourage more folks to post scenarios. Please forgive any inaccuracies, it's been 7 months since I was on the streets and I'm sure my memory of this call isn't perfect.
You and your partner are dispatched to a small, rural hospital for a cardiac arrest. The hospital is 45 minutes away by ground. (Due to weather, flights are grounded.) "No sweat," you figure. "They'll cancel us before we get there by ground." Your partner, a newly minted EMT-P, drives closer and closer, and no word from dispatch. You pull up to the hospital, swearing quietly to yourself as you radio in your arrival time. "I wonder what is going on here?" you think, as you put your gear on the cart to go inside.
You're waved (enthusiastically) into a hospital room near the small hospital's emergency room. You find a 52 year-old, obese woman being ventilated by BVM. A sinus rhythm shows on the monitor with a rate of 110. O2 sat is reading 99%. A 22 g. IV is present in the right hand with NS running in by pump at 150 mL/hr.
The nurses tell you the patient is an alcoholic well-known to them, and had asked to be admitted for detox. She was transferred to a hospital room in preparation for longer-term care at a treatment facility. An IV had been started, and 2 mg Lorazapam IV had been given.
From here, the story gets sketchy. Your best guess is that the patient had retched (nurses say she did not vomit) and gone unresponsive. The nurses say the patient had no pulse, and they began chest compressions on the hospital bed. They relate the monitor showed asystole at this point, though in the hustle, no one had thought to print out a strip. After ~5 minutes of CPR, (no meds given) the patient had regained a strong pulse with a sinus rhythm but remained unresponsive. The EMT relates the patient was apneic initially, but eventually she began spontaneous respirations 5 minutes before your arrival.
The local FP physician relates he had not attempted airway control because of the patient's excellent oxygen saturation and his admitted lack of experience managing airways.
Your initial assessment:
GI= ~90 kg woman in respiratory failure
MS= unresponsive to sternal rub and clavicle pinch. No corneal brush reflex.
Airway= Oral airway in place. Good chest rise with BVM ventilation.
Breathing= ~4-6 spontaneous respirations per minute, assisted and augmented to a rate of 12 by BVM with 100% oxygen. Good chest rise.
Circulation= skin cool and clammy. Radial pulse strong and regular, matching sinus rhythm on monitor. Nail beds pale. O2 sat 98-99%. BP - 106/55 by machine.
The emergency physician at the main hospital where you are based (45 minutes away) has accepted the patient. What do you do from here?
You and your partner are dispatched to a small, rural hospital for a cardiac arrest. The hospital is 45 minutes away by ground. (Due to weather, flights are grounded.) "No sweat," you figure. "They'll cancel us before we get there by ground." Your partner, a newly minted EMT-P, drives closer and closer, and no word from dispatch. You pull up to the hospital, swearing quietly to yourself as you radio in your arrival time. "I wonder what is going on here?" you think, as you put your gear on the cart to go inside.
You're waved (enthusiastically) into a hospital room near the small hospital's emergency room. You find a 52 year-old, obese woman being ventilated by BVM. A sinus rhythm shows on the monitor with a rate of 110. O2 sat is reading 99%. A 22 g. IV is present in the right hand with NS running in by pump at 150 mL/hr.
The nurses tell you the patient is an alcoholic well-known to them, and had asked to be admitted for detox. She was transferred to a hospital room in preparation for longer-term care at a treatment facility. An IV had been started, and 2 mg Lorazapam IV had been given.
From here, the story gets sketchy. Your best guess is that the patient had retched (nurses say she did not vomit) and gone unresponsive. The nurses say the patient had no pulse, and they began chest compressions on the hospital bed. They relate the monitor showed asystole at this point, though in the hustle, no one had thought to print out a strip. After ~5 minutes of CPR, (no meds given) the patient had regained a strong pulse with a sinus rhythm but remained unresponsive. The EMT relates the patient was apneic initially, but eventually she began spontaneous respirations 5 minutes before your arrival.
The local FP physician relates he had not attempted airway control because of the patient's excellent oxygen saturation and his admitted lack of experience managing airways.
Your initial assessment:
GI= ~90 kg woman in respiratory failure
MS= unresponsive to sternal rub and clavicle pinch. No corneal brush reflex.
Airway= Oral airway in place. Good chest rise with BVM ventilation.
Breathing= ~4-6 spontaneous respirations per minute, assisted and augmented to a rate of 12 by BVM with 100% oxygen. Good chest rise.
Circulation= skin cool and clammy. Radial pulse strong and regular, matching sinus rhythm on monitor. Nail beds pale. O2 sat 98-99%. BP - 106/55 by machine.
The emergency physician at the main hospital where you are based (45 minutes away) has accepted the patient. What do you do from here?
Yeah, there's a reason I'm a student these days. I miss it sometimes... but not as much as I thought I would.
