19y.o AMS

[GAmedik34]

EMT B
you get an 18 in the left AC and as you are drawing your labs the pt has an episode of urinary incontinance before passing out. you start to smell acetone on the breath that you did not notice before.


Vasovagal syncope

 

[chaz90]

im surprised nobody has offered to clean the patient yet. hes sitting in his own urine and could get an infection if we dont get him out of the clothes.

you cut off his clothes and put a johnny on him. as you are tying the johnny in the back you see 3 tampon tails coming out of the anus.

The back of the ambulance is really not conducive to stripping this patient down and cleaning him up. He's not sitting in a bucket of urine either. Much will be soaked up by clothes, and some will simply soak to the back and stretcher by gravity. Skin breakdown and ulcers aren't going to form in 30 minutes either. That being said, if I somehow saw these tampons, I'd pull them out. More accurately, I'd have my BLS partner pull them out.

Media hysteria has really blown this whole butt chugging and vodka soaked tampon thing out of proportion. Even in a college town with a large state university, we (including the hospital) had zero cases ever.

 

[rmabrey]

im surprised nobody has offered to clean the patient yet. hes sitting in his own urine and could get an infection if we dont get him out of the clothes.

you cut off his clothes and put a johnny on him. as you are tying the johnny in the back you see 3 tampon tails coming out of the anus.

If you dont have time to go code 1, you dont have time to clean and put on a diaper

 

[Tigger]

Media hysteria has really blown this whole butt chugging and vodka soaked tampon thing out of proportion. Even in a college town with a large state university, we (including the hospital) had zero cases ever.

Good luck finding actually documented cases of it period. Just one of those "stories" that the media caught on to and did not let go, despite little if any proof of it actually occurring at any significant rate.

And for what it's worth, I have no problem cleaning patients but the back of the ambulance while transporting emergent with an RSIed patient is just not one of those places. We try very hard not to unnecessarily move intubated patients to prevent tube dislodgement. Our patients are usually spider strapped to backboards with a c-collar and tube tie, and on a vent. So moving them around isn't exactly an easy proposition.

 

[Medic Tim]

I have actually had a pt who attempted this. He passed out while trying to insert it.

 

[EMT B]

Good luck finding actually documented cases of it period. Just one of those "stories" that the media caught on to and did not let go, despite little if any proof of it actually occurring at any significant rate.

And for what it's worth, I have no problem cleaning patients but the back of the ambulance while transporting emergent with an RSIed patient is just not one of those places. We try very hard not to unnecessarily move intubated patients to prevent tube dislodgement. Our patients are usually spider strapped to backboards with a c-collar and tube tie, and on a vent. So moving them around isn't exactly an easy proposition.

the way the instructor did this scenario was that as soon as the pt goes unconscious you cut everything and do a rapid trauma scan to cover your ***. during this scan is when you most likely would have found the tampons.

 

[Tigger]

I have actually had a pt who attempted this. He passed out while trying to insert it.

No kidding. Wow.

the way the instructor did this scenario was that as soon as the pt goes unconscious you cut everything and do a rapid trauma scan to cover your ***. during this scan is when you most likely would have found the tampons.

It might be a thought to get some clothes off him once he became unable control his own airway and intubation was considered. But not just to clean him as was earlier presented.

 

[DesertMedic66]

Good luck finding actually documented cases of it period. Just one of those "stories" that the media caught on to and did not let go, despite little if any proof of it actually occurring at any significant rate.

And for what it's worth, I have no problem cleaning patients but the back of the ambulance while transporting emergent with an RSIed patient is just not one of those places. We try very hard not to unnecessarily move intubated patients to prevent tube dislodgement. Our patients are usually spider strapped to backboards with a c-collar and tube tie, and on a vent. So moving them around isn't exactly an easy proposition.

I had a 13 year old girl do it at a party when her parents were out of town.

 

[Rialaigh]

If we are in the middle of transport, and the guy isnt bleeding out, and I can control the airway from the airway seat while belted in, I'm not unbuckling if the guy pee's two gallons and craps himself twice....We can take care of it when we get to the hospital.


And are we still shooting at alcoholic ketoacidosis or are we just saying alcohol poisoning at this point

 

[DesertMedic66]

im surprised nobody has offered to clean the patient yet. hes sitting in his own urine and could get an infection if we dont get him out of the clothes.

you cut off his clothes and put a johnny on him. as you are tying the johnny in the back you see 3 tampon tails coming out of the anus.

Not enough room in the back of the ambulance to try to clean a patient up. Let alone cleaning them is the least of my concerns when the patient has other issues going on.

What is a Johnny?

 

[EMT B]

johnny

 

[NomadicMedic]

A ridiculous zebra scenario.

It was fine until we got to "tampon tails".

Nice try, but a fail.

 

[Handsome Robb]

So since we have a controlled airway and stable vitals why are we going code 3?

Seconded on the BLS partner removing the tampons.

Thiamine isn't a bad idea. Rally bag anyone?

He's tubed lets do an NG/OG and hook it to suction so we don't have to clean up any more puke.

Also, he's 19 with no appreciable medical history...I'm not really worried about an infection from sitting in his urine for a few minutes. Hell, urban outdoorsman sit in their urine and sometimes feces for days on end without going septic.

 

[EMT B]

we are going code 3 because the high school is 40 mins from the hospital. also in my system if you have someone tubed you better be going code 3

why a rally pack? are you worried about WKS?

 

[STXmedic]

we are going code 3 because the high school is 40 mins from the hospital. also in my system if you have someone tubed you better be going code 3

Your system needs work, bud. A tube is a great reason not to go emergent. The immediate airway danger is done. Good job. Now you (both) get to breathe easy on the way in.

 

[Akulahawk]

we are going code 3 because the high school is 40 mins from the hospital. also in my system if you have someone tubed you better be going code 3

why a rally pack? are you worried about WKS?

The ETT itself isn't a reason for Code 3 travel. The reason for Code 3 travel has to do with the patient's condition. I've done Code 3 travel for patients that were awake, alert, oriented... and not intubated, but their condition necessitated it. I've gone Code 2 with many, many more... even those intubated. Your Medical Director probably feels that if a patient was emergently intubated, the underlying issue is the trigger for Code 3 travel. They may have had some problems with providers not recognizing the underlying issue was the problem... therefore now it's "Mongo intubated patent, Mongo take patient to hospital very fast."

 

[Akulahawk]

im surprised nobody has offered to clean the patient yet. hes sitting in his own urine and could get an infection if we dont get him out of the clothes.

you cut off his clothes and put a johnny on him. as you are tying the johnny in the back you see 3 tampon tails coming out of the anus.

Couple of things... if the patient becomes unconscious and then incontinent of urine on scene, I might cut off the clothes, but I'm not going to put a "johnny" on the patient. Also, someone that far "out" is going to get an OPA. If they "take" the OPA, then I'm going to place an ETT. If the patient becomes incontinent of urine or stool during transport from the field, cleaning him up is probably the last thing I need to do. If I can get to it, great. If I've got the room and the supplies, I'll get it done ASAP. In the field, I won't have the room or the supplies (usually) and people won't usually get any skin breakdowns that quickly. It's going to be mentioned to the team at the destination, so he'd be cleaned up very quickly at that point.

After the ETT placement is done, if necessary/protocol allows, I'd also place an NGT just because of that whole stomach decompression/vomiting thing...

 

[Handsome Robb]

we are going code 3 because the high school is 40 mins from the hospital. also in my system if you have someone tubed you better be going code 3

why a rally pack? are you worried about WKS?

That's unfortunate for you to have to endanger yourself and the public. A long transport isn't an indication for code 3, either. Now if this were a BLS truck or you were unable to secure the airway then by all means lets haul the mail.

WKS? A rally bag is a liter bag with some thiamine, frolic acid and a touch of mag. If you're allowed to do them prehospital lot it's generally only going to be thiamine and fluid. See: "banana bag"

Your system needs work, bud. A tube is a great reason not to go emergent. The immediate airway danger is done. Good job. Now you (both) get to breathe easy on the way in.

Agreed. Bolded the key phrase.

 

[Akulahawk]

That's unfortunate for you to have to endanger yourself and the public. A long transport isn't an indication for code 3, either. Now if this were a BLS truck or you were unable to secure the airway then by all means lets haul the mail.

WKS? A rally bag is a liter bag with some thiamine, frolic acid and a touch of mag. If you're allowed to do them prehospital lot it's generally only going to be thiamine and fluid. See: "banana bag"



Agreed. Bolded the key phrase.

Frolic Acid... it's the latest craze. :rofl:

I'm going to have to have mine with a good cup of java...

Now back to our regularly scheduled program...

 

[EMT B]

WKS?

Wernicke-Korsakoff syndrome

we use banana bags in the ER to prevent WKS in alcoholics


http://www.nlm.nih.gov/medlineplus/ency/article/000771.htm