Scenario time.

[AntonioEMT]

scenario

I allow a glucometer, <60 mg/dl, 2ml of rapid glucose 33%,...monitorate conscious, blood pression...and transport.

 

[certguy]

Scenerio

I've always believed in preparing for the worst and hoping for the best , so , I'd have her on 15 lpm by non - rebreather . I would also slam an NPA , get the suction ready , give her a pillow case ( I've done that too ) for the activated charcoal aftermath , and check on ALS ETA . If it's longer than our transport time , we go , if it's shorter or we can intercept in a shorter time , we ' ll do that . I would grab a FF and have him moniter vitals and be ready for a B/P crash while watching the LOC . I would also bring the bottles and ask mom if she remembers how full they were prior to this incident before we go , mom can ride with family , friends , or PD .

 

[certguy]

Oops , forgot to include assisting ventilations if needed , Ambu would be out and ready behind her just in case .

 

[KEVD18]

in fact I carry one on my belt

your joking right?

 

[NanNan&Dusty]

Thank you for all these "Scenario times", I will have my practical exam on 01/09 and 01/14. Now I am scared to dead...... because it's hard to have all these different scenario when we are practice by ourselves. Our instrutors never gave us any scenario, only asked us to practice practice and practice but w/o the scenario , I don't know how...

 

[Aileana]

I'd do a glucometry stick first to see her levels, respond to the result accordingly (BLS here can do glucometry). Write down med names and suspected dosages taken, monitor vitals (and prepare to act according to changes). As far as I know, charcoal isn't in our BLS or ALS standards, so I would keep emesis bags/basins within close reach, and transport to the nearest hospital.

 

[daedalus]

I am not entirely sure what all those meds do to a pt, but have picked up some things from the replies.

The BP is still normal for that patient, but you need more than one reading to see where it's going.

She is an Insulin Dependant Diabetic. So her cells will have trouble with glucose uptake. Won't this make her hyperglycaemic? She avoids the insulin question though, this could be because shes feeling guilty for not taking it.

I wouldn't administer glucose until a glucometer tells me to do otherwise, if she was cold/wet I would consider it more strongly.

fm_emt suggested that TCAs inhibit K+ uptake by myocytes?

But insulin supports K+ movement into cells, so would rapid acting insulin be a good idea if she starts showing some hypokalaemic EKG patterns? Just throwing it out there?

Lastly I would do something to protect the airway, perhaps lateral.

Lifting the legs and getting up a large bore should save you if her BP falls until u get to the hosp.

What u guys think?

If she avoided the question on insulin, and also took many other medications, its reasonable to think she also injected lots of insulin to top it all off. Never assume she did not take it, instead, keep a high index of suspicion. Do a full assesment and check RBS.

As for this pt in the thread, call ALS, get the medication bottles, get a history, put her on some O2, throw her in the ambulance and do the assesment in route. Follow protocol on glucose/charcol. Once ALS meets you they can put her on the EKG and stick a line in her.