Scenario For Bls Providers

[skyemt]

So, I gotta ask you:

if this is a scenario, what was supposed to tip us off to the outcome? I don't see how it is thought provoking to go through a scenario that is completely "atypical". I bet that some of the higher educated members here can present cases that present almost identical to this with completely different diagnosis.

And so, in your scenario, when someone suggests something, you immediately tell them that they're completely wrong(like suggesting a Pulmonary Embolism, or to consider bagging the patient, both perfectly logical considerations.)

So just out of curiosity, what did you do for the pt and what did you think it was... and why?

if you don't like the scenario, move on along... no need to come out here and criticize for no reason.

the point is to realize that there are MANY atypical presentations, and we are supposed to be AWARE of all of them.

assessing is about thinking... the very nature of a thought provoking scenario is to come up with possible differential diagnoses, and atypical presentations. if you just want to scoop and run, go back to the 70's.

as for giving hints, forgive me if i tried to steer the group in the right direction!

those that participated liked it. then you come along after the fact to poke holes in it... what is the point of that, really?

since you are so knowledgeable about how to do a good scenario, please, i look forward to seeing yours... although i doubt i will.

 

[Vizior]

if you don't like the scenario, move on along... no need to come out here and criticize for no reason.

the point is to realize that there are MANY atypical presentations, and we are supposed to be AWARE of all of them.

assessing is about thinking... the very nature of a thought provoking scenario is to come up with possible differential diagnoses, and atypical presentations. if you just want to scoop and run, go back to the 70's.

as for giving hints, forgive me if i tried to steer the group in the right direction!

those that participated liked it. then you come along after the fact to poke holes in it... what is the point of that, really?

since you are so knowledgeable about how to do a good scenario, please, i look forward to seeing yours... although i doubt i will.

I'm not gonna do a scenario on here b/c I don't see the point. There are plenty of professionals out there that have written books about it. I understand that you're trying to convey the point that there are many different presentations of different conditions.

What I'm trying to point out is this: you proposed a scenario that you consider "atypical", and then you jumped on people that were going down perfectly reasonable paths based on the information given. You have blinders on, and are convinced that there is only one possible diagnosis, while in the field, there are gonna be many, many different thoughts to consider.

I want to know is what did you find in the field here that absolutely points to CHF secondary to an MI? What is a complete contraindication to rule out a pulmonary embolism?

You can either run a scenario or you can tell a story. But you can't just expect people to come up with the proper diagnosis, with just BLS diagnostic equipment in the field, the closest you can come is having a bunch of educated guesses.

And thus I'm asking again, honestly, what did you think the issue was from a BLS standpoint going into the hospital, and what interventions did you perform?

 

[skyemt]

I'm not gonna do a scenario on here b/c I don't see the point. There are plenty of professionals out there that have written books about it. I understand that you're trying to convey the point that there are many different presentations of different conditions.

What I'm trying to point out is this: you proposed a scenario that you consider "atypical", and then you jumped on people that were going down perfectly reasonable paths based on the information given. You have blinders on, and are convinced that there is only one possible diagnosis, while in the field, there are gonna be many, many different thoughts to consider.

I want to know is what did you find in the field here that absolutely points to CHF secondary to an MI? What is a complete contraindication to rule out a pulmonary embolism?

You can either run a scenario or you can tell a story. But you can't just expect people to come up with the proper diagnosis, with just BLS diagnostic equipment in the field, the closest you can come is having a bunch of educated guesses.

And thus I'm asking again, honestly, what did you think the issue was from a BLS standpoint going into the hospital, and what interventions did you perform?

listen, you proclaim that you do not even like scenarios out here, and don't believe in them...
i'm not going to waste my time when you are not interested in them in the first place, and you just want to poke holes.

what i expected were thoughtful questions, and that's what i got. a good job by all, and those who participated liked it.

move along, and whine elsewhere.

 

[LucidResq]

And thus I'm asking again, honestly, what did you think the issue was from a BLS standpoint going into the hospital, and what interventions did you perform?

Yeah I'm curious. What did you think it could be? What did you do about it?

I think it's fine to use a scenario with an atypical presentation, but don't be surprised when people come up with answers based on typical presentations. Just don't be so quick to cut people down for their answers, especially when those answers are logically based on the information given.

 

[skyemt]

well, we called for ALS, but didn't get it...

due to the sudden onset of symptoms that woke her out of her sleep, combined with her associated syncopal episode and resp distress, we suspected (feared) something cardiac (all that wheezes is not asthma)...

we called med control to run it by them... they agreed, gave us orders for ASA, and had us call the ER to alert them of possible MI coming in...

so, did it matter? i would like to think so...
have we studied atypical presentations? yes...

did it prevent us from strictly thinking resp? yes... med control wanted our assessment, because they may have considered a resp treatment.

she did not fit the profile of PE, so we didn't really go there...due to her age and presentation, cardiac origin was the chief worry.

so, if you find no value in these exercises, so be it.

i know that medics practice differential diagnoses all the time, and are always thinking about underlying causes.

if you don't think BLS involves good assessments and a good history, i can't really help you.

 

[certguy]

May I suggest that a scenerio is a learning experience and those of us who post scenerios should not criticise ( I hope I spelled that right ) , but guide the participants through it . This should be an educational , not confrontational enviorment . People will learn more if they enjoy it and are comfortable , rather than offended .


Craig


TIME OUT ! take a deep breath and work together .

 

[piranah]

i suggested CHF earlier....but i coulda been many things

 

[REMSI Medic 10]

start initian assesment so I would start her on some 15L non-rebreather reassess vitals ever 5-10 minutes, contact hospital and give patient stats, arrive at hospital, etc.

 

[BossyCow]

Given her age and the respiratory issues, she would have been a quick load and go like heck regardless of what is causing it. With ALS unavailable, edema and audible wheezing and gurgling, CHF has to be a concern, whether likely or not.

Since you listed this as an ALS unavailable, BLS call... treatment would have been based on what I see, not what I think it might be from. High Flow O2, with the combo of 'gurgling' and edema I would have given ASA, kept the monitor on her, kept the BVM close and been ready for when she coded.

This would have been not much time on scene for questions and Hx taking. Pedal to the metal and get her to the ER.

 

[JPINFV]

Come on people, it's a scenario. Ok, so you start transport immediately. So what? Are you not going to continue doing an assessment during transport? Even if you (generic) are maxed out with treatments, I don't see why that should preclude you from digging a little deeper and developing a rational hypothesis (better known as a differential diagnosis) based off of what you uncover. If people really don't see a point in actually attempting to examine the patient past the point of "ALS, immediate transport, high flow O2," then whats the point of even running a scenario?

 

[emt19723]

i was thinking CHF myself before i read the actual diagnosis from the OP. sudden onset, syncope, 95% on 15 lpm, gurgling as shes breathing, and swollen ankles/feet. sounds pretty textbook right there.

 

[YouthCorps1]

SAMPLE, when did it start, what does it feel like, has it happened in the past? start this patient on a nasal canula at 7-lpm just in case. any LOC? asthma patient? does this pt have an inhaler? has it been prescribed by a dr? start albuterol via nebulizer or maybe epinepherine? transport with the head elevated .

 

[JPINFV]

SAMPLE, when did it start, what does it feel like, has it happened in the past? start this patient on a nasal canula at 7-lpm just in case. any LOC? asthma patient? does this pt have an inhaler? has it been prescribed by a dr? start albuterol via nebulizer or maybe epinepherine? transport with the head elevated .

SAMPLE? Welcome to post 3. Inhaler? Welcome to the M in SAMPLE. Nasal cannula at 7 LPM? I'm sorry, that flow rate is in a different castle (try again).

 

[reaper]

That first week of EMT school, must be getting good!

 

[KEVD18]

check is profile, he's 15 years old(like that wasnt blazingly apparent)

 

[EMTinNEPA]

SAMPLE, when did it start, what does it feel like, has it happened in the past? start this patient on a nasal canula at 7-lpm just in case. any LOC? asthma patient? does this pt have an inhaler? has it been prescribed by a dr? start albuterol via nebulizer or maybe epinepherine? transport with the head elevated .

SAMPLE? Welcome to post #3. Nasal canulla at 7lpm? You are aware that nasal cannulas are only used to administer up to 6lpm, right? And even then they're only delivering about 25% O2. LOC? It was established by skyemt that the patient had a syncopal episode which is why the daughter called. History of asthma? No. Welcome to post #4. You need a perscription from a doctor for an inhaler but your BLS truck carries nebulizers and epinepherine? Man, I'm working in the wrong region. You need medical command for epi?

 

[EMERG2011]

Her vitals are concerning. It sounds like it might be a pulmonary embolism, but it could be several other things. The treatment will be the same regardless. Considering her respiratory rate and depth I would strongly consider bagging her. I would load and go unless ALS was nearby. Position of comfort... reassess vitals every 5 min. or so. Keep a close eye on her airway and mental status. Prepare to ventilate, suction, and defibrillate.

Considering the abnormal lung sounds I'd be thinking simple pneumonia, especially if she's sedentary. While we should have an elevated awareness for PE etc, this presentation doesnt sound like your typical PE. Give her O2 15 by NRB, get ALS on the line and check their ETA. If ALS is too far, load and go to the nearest hospital lights and sirens.