NomadicMedic
I know a guy who knows a guy.
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You are dispatched priority to a church for a reported syncopal episode.
Just to set the stage, it's a hot day, about 85°. You're in an ALS ambulance, both providers are paramedics. You're about 10 minutes away from a Community Hospital which has CT and that's about it. No surgeon on weekends, no neuro no PCI. Aproximately 50 minutes by ground to the level one trauma center and about 40 minutes by ground to the closest stroke/PCI center.
You arrive on scene to find a 40-year-old female, supine on the floor in the church hall. She doesn't seem to quite be tracking you correctly and is slow to answer questions, but she is answering the questions that you ask appropriately. The bystanders relate that she "just passed out". No seizure. She's new to the church and nobody knows her history or really anything about her. Her 14-year-old daughter is there and said that mom passed out twice at home yesterday. She's alert enough to be able to tell you her name and her date of birth but is adamantly refusing any treatment or transport.
"She does not want to go, she does not want to go, she absolutely does not want to go!"
Your first set of vital signs; strong radial pulse with a rate of about 90, respirations about 16 and unlabored. Orthostatic blood pressure is exactly the same within a point or two, 142/84. You get a blood sugar and it's 91. Pupils are PEARRL. She's able to stand up for that orthostatic without issue, not complaining of any pain.
Bystanders, the kid and you and your partner lay on the full-court press because something doesn't seem quite right and you still want her to go to the emergency department to be assessed further. After about 25 minutes of cajoling, you finally get her to agree to go to the local Community Hospital. As your partner goes to grab the stretcher, which had already been put away because you thought it was going to be a refusal, she once again becomes unresponsive. From talking to you too out cold. In the blink of an eye. Fully. GCS of three. No one home, nothing you can do to arouse her.
Now what?
Just to set the stage, it's a hot day, about 85°. You're in an ALS ambulance, both providers are paramedics. You're about 10 minutes away from a Community Hospital which has CT and that's about it. No surgeon on weekends, no neuro no PCI. Aproximately 50 minutes by ground to the level one trauma center and about 40 minutes by ground to the closest stroke/PCI center.
You arrive on scene to find a 40-year-old female, supine on the floor in the church hall. She doesn't seem to quite be tracking you correctly and is slow to answer questions, but she is answering the questions that you ask appropriately. The bystanders relate that she "just passed out". No seizure. She's new to the church and nobody knows her history or really anything about her. Her 14-year-old daughter is there and said that mom passed out twice at home yesterday. She's alert enough to be able to tell you her name and her date of birth but is adamantly refusing any treatment or transport.
"She does not want to go, she does not want to go, she absolutely does not want to go!"
Your first set of vital signs; strong radial pulse with a rate of about 90, respirations about 16 and unlabored. Orthostatic blood pressure is exactly the same within a point or two, 142/84. You get a blood sugar and it's 91. Pupils are PEARRL. She's able to stand up for that orthostatic without issue, not complaining of any pain.
Bystanders, the kid and you and your partner lay on the full-court press because something doesn't seem quite right and you still want her to go to the emergency department to be assessed further. After about 25 minutes of cajoling, you finally get her to agree to go to the local Community Hospital. As your partner goes to grab the stretcher, which had already been put away because you thought it was going to be a refusal, she once again becomes unresponsive. From talking to you too out cold. In the blink of an eye. Fully. GCS of three. No one home, nothing you can do to arouse her.
Now what?
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). If no pulse, do CPR. If not, I would grab a 12 lead, continue asking questions from kid about any possible hospitalizations, medications, etc.
