Emt approach

[sisoybolso]

DISPATCHER TELLS YOU

_8 YEARS OLD MALE
_UNCONSCIOUS
_ WAS PLAYING FOOTBALL AT RECESS ( 90 DEGREES OUTSIDE)
_RESPIRATIONS 8
_PULSE 110
_BP UNKNOWN
_ Hx UNKNOWN

HOW WOULD YOU TAKE CARE OF THIS PATIENT FROM A TO Z
STARTING FROM SCENE SAFETY TO TRANSPORT INCLUDING ACTIONS THAT YOU TAKE.
IF ANY QUESTIONS ABOUT THE SCENE PLEASE ASK ME AND I WILL GIVE YOU DETAILS.
tHANK YOU FOR YOUR TIME

 

[Medic Tim]

DISPATCHER TELLS YOU

_8 YEARS OLD MALE
_UNCONSCIOUS
_ WAS PLAYING FOOTBALL AT RECESS ( 90 DEGREES OUTSIDE)
_RESPIRATIONS 8
_PULSE 110
_BP UNKNOWN
_ Hx UNKNOWN

HOW WOULD YOU TAKE CARE OF THIS PATIENT FROM A TO Z
STARTING FROM SCENE SAFETY TO TRANSPORT INCLUDING ACTIONS THAT YOU TAKE.
IF ANY QUESTIONS ABOUT THE SCENE PLEASE ASK ME AND I WILL GIVE YOU DETAILS.
tHANK YOU FOR YOUR TIME

welcome to EMT life

Are you asking because you are not sure (ie, homework) or is this a call you had and want to present it as a scenario?

and there is no need to YELL

 

[Achilles]

Why are you yelling?
I won't do you're Homework.

What would you do?

 

[chaz90]

LOUD NOISES!

Well, first things first, let's manage this patient's breathing. This is obviously slow and inadequate for an 8 year old, so BVM assisted ventilations as we start to package and get more info. Let's get a better history. He was playing outside in hot weather and then collapsed. Did anyone see it? What happened directly before? What other assessment findings do we have? EtCO2? SpO2? Depth of breathing? Blood Glucose? How about we actually get a BP. Neuro exam findings? Either way, my next step in the rig would be to get an IV and have fluids hung and ready. The remainder of my treatments need more assessment findings and history than we have so far. Are there no adults on scene that may have been supervising him? Perhaps older sibling or child with contact info for parents?

BTW, number one on my differentials right now is seizure and now post-ictal. We shall see though.

Also, I hope this isn't a homework question I was suckered into. I'm a trusting guy.

 

[sisoybolso]

I am so sorry about upper case letters.
This is not a homework I am a new EMT and that was my first call and I wanted to see how others EMTs would manage this situation.
I am from a small city in Lancaster Pa.( nothing ever happens here)
Anyways, thank you for your time.
As I get to the scene I was approached by one of the teachers and the principal, they stated the kid was playing in the hot and just collapsed.
My first concern was his airway, breathing and circulation.
Also I was concern about any trauma.

 

[J B]

If pt is unresponsive, doesn't that make it an automatic upgrade to ALS unless you're very close to hospital?

Follow ABCs, and I guess we can mostly rule out trauma since other people saw him "just collapse"?

I'm also a new EMT. I can imagine this being scary but it is pretty much right out of a textbook.

Well, first things first, let's manage this patient's breathing. This is obviously slow and inadequate for an 8 year old, so BVM assisted ventilations as we start to package and get more info.

I notice you make no mention of airway adjuncts. The textbook says unresponsive pt should be getting an OPA. Did you just forget, or would you not use OPA/NPA in this patient?

I've always kind of questioned this because what if you put an OPA in a pt like this, he wakes up and gags/vomits/aspirates? What if he wakes up enough to have a gag reflex, but not enough to pull out the OPA? It seems like an OPA has a good chance of making the situation much worse.

 

[chaz90]

I notice you make no mention of airway adjuncts. The textbook says unresponsive pt should be getting an OPA. Did you just forget, or would you not use OPA/NPA in this patient?

I've always kind of questioned this because what if you put an OPA in a pt like this, he wakes up and gags/vomits/aspirates? What if he wakes up enough to have a gag reflex, but not enough to pull out the OPA? It seems like an OPA has a good chance of making the situation much worse.

Most unresponsive patients still have enough of a gag reflex to prevent OPA usage. I would probably put in an NPA (more likely two), but would hold off on even trying for an OPA or not until I find out if it was a seizure. If the patient doesn't begin to regain consciousness, I'd then move towards at least trying an OPA to see if a gag is intact. If they gag, remove before they vomit. If they vomit, have suction at the ready.

 

[Mariemt]

Assist vents first
load him into air conditioned ambulance. Get a bp and to hospital if a ways out do an als intercept
Body temp
Bgl
Need to know allergies. School know? How does his face, neck look? Lung sounds? Need an epi pen?
How did he look this morning at school? Hopefully teacher close by , have teacher ride along to give you last several hours of history
Als please

 

[J B]

Most unresponsive patients still have enough of a gag reflex to prevent OPA usage. I would probably put in an NPA (more likely two), but would hold off on even trying for an OPA or not until I find out if it was a seizure. If the patient doesn't begin to regain consciousness, I'd then move towards at least trying an OPA to see if a gag is intact. If they gag, remove before they vomit. If they vomit, have suction at the ready.

Sounds good, thanks for clarifying.

 

[Anonymous]

First things first! This patient needs C-Spine!!!












I Kid. I Kid.

 

[Wheel]

First things first! This patient needs C-Spine!!!












I Kid. I Kid.

You kid, but a fall with altered loc would be boarded in many places. It makes me cringe a bit.

 

[Wes]

In all honesty, I might have someone take c-spine and stabilize the neck until we have an idea of what's going on.

 

[phideux]

First things first! This patient needs C-Spine!!!











I Kid. I Kid.

And a NRB @ 15LPM :rofl:

 

[Wes]

Sadly, the EMT curriculum has been watered down to C-spine, NRB at 15 LPM, and request ALS.

 

[Wheel]

DISPATCHER TELLS YOU

_8 YEARS OLD MALE
_UNCONSCIOUS
_ WAS PLAYING FOOTBALL AT RECESS ( 90 DEGREES OUTSIDE)
_RESPIRATIONS 8
_PULSE 110
_BP UNKNOWN
_ Hx UNKNOWN

HOW WOULD YOU TAKE CARE OF THIS PATIENT FROM A TO Z
STARTING FROM SCENE SAFETY TO TRANSPORT INCLUDING ACTIONS THAT YOU TAKE.
IF ANY QUESTIONS ABOUT THE SCENE PLEASE ASK ME AND I WILL GIVE YOU DETAILS.
tHANK YOU FOR YOUR TIME

I read this in the voice of the drill instructor from full metal jacket, obscenities added of course.

 

[Mariemt]

Sadly, the EMT curriculum has been watered down to C-spine, NRB at 15 LPM, and request ALS.

Actually, if you want to pass the nremt you need to titrate O2. Over oxygenating a patient with a head injury or on a cardiac call will get you a big ol wrong answer.

Our protocols have us keeping a code patient in the 94% range.

 

[Wes]

You just made my day!

 

[EMTnurse]

If pt is unresponsive, doesn't that make it an automatic upgrade to ALS unless you're very close to hospital?

Follow ABCs, and I guess we can mostly rule out trauma since other people saw him "just collapse"?

I'm also a new EMT. I can imagine this being scary but it is pretty much right out of a textbook.




I notice you make no mention of airway adjuncts. The textbook says unresponsive pt should be getting an OPA. Did you just forget, or would you not use OPA/NPA in this patient?

I've always kind of questioned this because what if you put an OPA in a pt like this, he wakes up and gags/vomits/aspirates? What if he wakes up enough to have a gag reflex, but not enough to pull out the OPA? It seems like an OPA has a good chance of making the situation much worse.

I wouldn't necessarily use one unless I was having difficulty establishing and maintaining a patent airway. I tend towards the least amount if intervention to achieve my goal.

 

[Mariemt]

If pt is unresponsive, doesn't that make it an automatic upgrade to ALS unless you're very close to hospital?

Follow ABCs, and I guess we can mostly rule out trauma since other people saw him "just collapse"?

I'm also a new EMT. I can imagine this being scary but it is pretty much right out of a textbook.




I notice you make no mention of airway adjuncts. The textbook says unresponsive pt should be getting an OPA. Did you just forget, or would you not use OPA/NPA in this patient?

I've always kind of questioned this because what if you put an OPA in a pt like this, he wakes up and gags/vomits/aspirates? What if he wakes up enough to have a gag reflex, but not enough to pull out the OPA? It seems like an OPA has a good chance of making the situation much worse.

It depends, is he having trouble breathing due to snoring? Can you open his airway by the head tilt chin lift?
The opa will benefit him then, but if his airway is open already the opa may just cause him to vomit

 

[Chronic510]

This is a rather simple scenario lol

I would have my partner hold c-spine.
Check ABC's

Breathing is slow, but if perfusion is adequate? I'd use a non-rebreather at 15lpm. You can never use too much oxygen.

After i would try and get a sample/history and determine wether c-spining this patient is necessary. After that I would pack'em and go. I would get vitals in the rig on the way. and re-asses for any changes.

As an EMT we are limited to what we can do. Just because someone is unconcious doesnt make it an ALS call. From the scenario you've given? This patients vitals seem rather stable.


(Btw, for registry purpose's? You'd typically slide in an npa, and assisted ventilations)

But keep in mind. That can change at any given moment