64 yo M fall, not dangerous (per dispatch)

Burritomedic1127

Burritomedic1127

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At 0200 your ALS rig gets dispatched to one of the city MBTA stops for the fall, not dangerous. OA you find a 64 yo M local drunk who you know has frequent episodes of Rapid Afib with RVR and very poor vascular access, pt is walking back and forth near train platform, sits down crosses his legs and complains of SOB.

Get her done..
 
Taxi voucher? Just kidding.

Vitals, skin signs, EKG, onset of SOB, lung sounds, meds pt takes, and have they been drinking.
 
1) Why is this in the Health and Fitness section?

2) You basically just gave us the answer... (Eta: disregard this bullet. Misread the initial post)

3) To play the game, how about vitals?

4) It was dispatched as a Fall, so I will definitely not be bringing in my O2 bottle.
 
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STXmedic said:
1) Why is this in the Health and Fitness section?

2) You basically just gave us the answer...

3) To play the game, how about vitals?

4) It was dispatched as a Fall, so I will definitely not be bringing in my O2 bottle.
Click to expand...

But you'll be bringing in a backboard and C-collar right? :p
 
Pt was AOx4 and has not been drinking (shocker). Stated he fell yesterday morning off of the platform, about 5 feet, onto the tracks just missing the 3rd rail. No LOC and no one witnessed the fall. HR 70 RR 22 non labored with clear LS in all fields, pt refused manual BP just demanded he goes to the hospital

Hx Afib, COPD, ETOH abuse, hyperlipidemia
Meds Metoprolol, Albuterol, Simvastatin
 
Burritomedic1127 said:
Pt was AOx4 and has not been drinking (shocker). Stated he fell yesterday morning off of the platform, about 5 feet, onto the tracks just missing the 3rd rail. No LOC and no one witnessed the fall. HR 70 RR 22 non labored with clear LS in all fields, pt refused manual BP just demanded he goes to the hospital

Hx Afib, COPD, ETOH abuse, hyperlipidemia
Meds Metoprolol, Albuterol, Simvastatin
Click to expand...

Skin signs? 12-lead? SpO2? Any neuro deficits? Pupils? Any injuries on his head, chest, abd? Pain? Can he take a deep breath?
 
Is the patient actually taking said medications?
 
So... why did he call ems today? Because he fell yesterday?

And my taxi idea is coming back. (one agency I worked for we had taxi vouchers for, what so far appears to be, this reason.)
 
Monitor and transport. $300 taxi service. If he consented I would probably board and cspine to cover my butt O wait NO etoh? Then just load and go if he clears nexus!. I dont really see what you want us to solve here? Is there some strange underlying thing we are missing? I will go with Neurally Mediated Syncope brought on by urination? Hows that?
 
He did fall... Rectal Tone Test?
 
samiam said:
Monitor and transport. $300 taxi service. If he consented I would probably board and cspine to cover my butt O wait NO etoh? Then just load and go if he clears nexus!. I dont really see what you want us to solve here? Is there some strange underlying thing we are missing? I will go with Neurally Mediated Syncope brought on by urination? Hows that?
Click to expand...

Even if he was wasted drunk and walking around complaining of SOB as described I wouldn't backboard him. Agreed with the rest of your post.
 
Previous call looking for validation?
 
Burritomedic1127 said:
Pt was AOx4 and has not been drinking (shocker). Stated he fell yesterday morning off of the platform, about 5 feet, onto the tracks just missing the 3rd rail. No LOC and no one witnessed the fall. HR 70 RR 22 non labored with clear LS in all fields, pt refused manual BP just demanded he goes to the hospital
Click to expand...
So take him to the damn hospital. He wants to go, he is relatively asymptomatic, I'm assuming he either doesn't want a 12 lead or it is normal.

Sir, please walk to the ambulance, sit on the bench, we are going to take a nice slow ride to the ER.

we all go home happy at the end of the day
 
chaz90 said:
Even if he was wasted drunk and walking around complaining of SOB as described I wouldn't backboard him. Agreed with the rest of your post.
Click to expand...

I changed my mind once i read it again and saw no etoh and was too lazy to erase it so i just added on :)
 
OK so in reality I would tell the guy if he wants to go to the ER then he needs to sign the accept treatment and transport line. Then document he refused all care and take him to the ER. And bill him.
 
My bad slow response here

Pt walked to truck, no obvious signs of trauma, skin color WPD, no signs of respiratory distress. Pt started complaining of non radiating back pain between the shoulder blades. No head neck or back pain on palpation. Pt refused backboard because it makes his breathing worse but allowed for BP once in the truck. Pt was hypotensive in the 80s. Afib on the monitor in the 70s, 12 lead unremarkable, 98 on RA, NIBP 60/40

Local hosp 2 mins away
Trauma center 15 mins away
 
Unknown if pt has been taking medications, no neuro deficits noted, PEARLA, both legs have old wounds that have been treated at the hospital recently, no dinner date or check of rectal tone. IV access is a 22 in pts Thumbs that blows with fluid, humeral IO access obtained. Blood sugar 104 Lactate 0.2 Pt was afebrile

Transport to local hospital (2 mins away) or trauma/everything hospital (15 min away)? and would you trauma alert?
 
Did you seriously start a humeral IO on this guy?
 
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