Hurry Hurry Oh Please Hurry!

[fma08]

fixed at 5mm

 

[ukmedic]

she has had a brain stem cva? fall yesterday was the start of it with loss of coordination hence the fall...there rest fits into place

 

[BossyCow]

Sounds to me like the pt was fine prior to the fall. If she tripped, that means she was up, mobile and active before she tripped. Sick people lying in bed or sitting in chair don't trip. I'm not buying the 'she tripped' completely, because a loss of coordination, diminished LOC or sycope, could have caused her to 'trip'. Are the blood thinners something she's been taking for a long time, or are they new?

 

[fma08]

she had been getting better from the stroke... but again... thats the story from the staff... we weren't buying it much either, not even joking, hard to run this call with out any cooperation from the nurses eh? she's been on them since she had the stroke.

 

[Medic9]

could it be a subdural hematoma?

 

[fma08]

certainly could be

 

[Medic9]

Ok, so fill us in with more info so we can start treating, please.

 

[fma08]

well you gotta transport her to the ER, you got at 10 min transport time, check over the info everyone else asked, see what else you want to know, and start treating

 

[Medic9]

Okay, went all the way back and took notes:
snoring, gurgling resp 28-30
BP 50/30
no radial pulse detected
BiS 200mg/dL
BP 60/40 after dopamine drip
pupils are fixed 5mm
extremities are cool, clammy. core is warm
meds- antibiotics, blood thinners
No beta-blockers
Small hematoma appeared shortly after the fall and has not grown in size.
monitor shows a junctional rhythm

Pt hx- Stroke but has been improving since coming to the nursing facility. She "tripped" and fell yesterday. Her family noticed a change in her and is now unresponsive.

The staff is like most at nursing home, less than helpful. I am going to load and go with the patient. Considering c-spine immoblization because of the fall. Contact the receiving hospital, give a report and ask for further orders. Suction the airway, continue supplimental O2. Vitals are telling me she is in some kind of shock. Now what...

 

[mdkemt]

My first thought is head injury. I would be thinking subderal bleed.

MDKEMT

 

[Medic9]

A subdural bleed is what I said a few posts back. So... after the dopamine drip and getting her BP up is she starting to become responsive in any way?

 

[fma08]

still unresponsive

 

[Medic9]

Is there any fluid coming from the ears?

 

[fma08]

none noted, respirations around 6 and shallow now

 

[Medic9]

should have noted at this point she is intubated, does that make any change?
I have a feeling that no treatment at this point is going to save her. Did the hospital give me any orders when I called in my report?

 

[fma08]

no orders, however pt's face starts swelling with massive sub-q emphysema after bagging through the tube

 

[Medic9]

Did she get a pneumothorax from the fall?

 

[fma08]

bagging is increasingly difficult and you are not hearing much if anything for lung sounds

 

[Medic9]

needle decompression?

 

[fma08]

no air/blood return