Unconscious kid lying in a room

[UsualSuspect147]

How do you know he doesn't have a genetic mitochondrial disorder that inhibits him from aerobic metabolism and doesn't need a dose of bicarb to reverse his acute acidosis?


If it looks like a duck, quacks like a duck, and walks like a duck, it is a duck until proven otherwise.

When you hear hoofbeats, think horses.

If he is breathing, then he doesn't need the narcan anyway.

If he did take drugs, how do you know it was an opioid?

What if it was a benzo, a barbiturate, THC, an amphetamine? A chemical like whiteout or paint? (can you believe they still make that stuff?, who uses it?)

What if it was a large dose opioid and you have to set up a narcan drip?

But here is the rub.

The more what if's you know, the less practical it becomes to look for them.

Start with the basics, air in and out, blood round and round.

GREAT post.

 

[medichopeful]

How would you get them onto your gurney or transport the patient if they are unconscious and lying on the floor after you c-spine the patient?

If you c-spine them, then yes backboard is the way to go (or possible a scoop). If you didn't c-spine them, pick them up and put them on whatever you're using to bring them to your ambulance or stretcher (for example, stair-chair->stretcher->ambulance)

 

[medichopeful]

Wouldn't incontinence be a possible indicator of a c-spine injury?

Not necessarily. Other things can cause incontinence too.

 

[medichopeful]

Point taken. I guess it just sucks to be lumped into a group of people that are capable of nothing more than the minimum. The obvious solution is to increase my education, which is unfortunately just not in the cards right now.

You are increasing it Tobias, just not with new certs! Teaching yourself and learning is a GREAT way to increase understanding.

 

[crispy91]

Honestly, I wouldn't have backboarded the pt. Sounds like something alcohol related, with no trauma. On scene, remember to focuss on your life threats, then worry about things like hx, hpi, and all that. The roomate would probably be your most valuable source of information. As far as your assessment goes, remember that the unresponsive pt needs to be tx to the hospital immediately. Worry about hx either en route, or before you leave. Just my opinions though. Other than that, you did pretty good.

 

[Doczilla]

And the award goes to Doczilla for the most amusing family friendly explanation of a sensitive topic.

I've got nothing to add here other than this.

Yay!

 

[Veneficus]

Folks if someone says something that is incorrect feel free to correct them but let's do it in a friendly, professional way. There are those who have lot's of info and experience and those who have little. The one's who have little will stop listening if you slap them down for giving the wrong answer. Eventually they stop trying to answer and then they stop trying to learn. I am disappointed with the tone of some of the posts in this thread.

Sorry,

I think there is some residual anghst from the last thread on giving narcan to EMT-Bs.

After pages of why it should or shouldn't be permitted, a few posts here basically unwittingly proved the point on why basics don't need more tricks in their bag.

In my initial response, I did phrase the question because I wanted to hear the reason for the answer. I expected 1 of 2

1. Because my instructor told me.
2. "just in case"

As an interesting anecdote I was having lunch with a Dr. last year during a PALS class we were teaching.

This Dr. and I do not see eye to eye on just about anything, but we can tolerate each other and work well together.

During the meal he brought up a good point I think is worth sharing in this thread.

The new students saw us instructors as the absolute authority on the topic by virtue of nothing more than our instructor title.

The next time they take a PALS class, they will challenge their "new" instructors if they relate anything in contra to what we said.

They have absolutely no way to judge a competent instructor from a poor one other than how the instructor makes them feel.

If you make them feel good, they will say you are a good instructor no matter how little they learned.

If you make them feel bad, they say that you were terrible no matter how much they learned.

But they still have no idea who is competent and who is not.

 

[abckidsmom]

Sorry,

I think there is some residual anghst from the last thread on giving narcan to EMT-Bs.

After pages of why it should or shouldn't be permitted, a few posts here basically unwittingly proved the point on why basics don't need more tricks in their bag.

In my initial response, I did phrase the question because I wanted to hear the reason for the answer. I expected 1 of 2

1. Because my instructor told me.
2. "just in case"

As an interesting anecdote I was having lunch with a Dr. last year during a PALS class we were teaching.

This Dr. and I do not see eye to eye on just about anything, but we can tolerate each other and work well together.

During the meal he brought up a good point I think is worth sharing in this thread.

The new students saw us instructors as the absolute authority on the topic by virtue of nothing more than our instructor title.

The next time they take a PALS class, they will challenge their "new" instructors if they relate anything in contra to what we said.

They have absolutely no way to judge a competent instructor from a poor one other than how the instructor makes them feel.

If you make them feel good, they will say you are a good instructor no matter how little they learned.

If you make them feel bad, they say that you were terrible no matter how much they learned.

But they still have no idea who is competent and who is not.

This is an extremely good point. It also applies to their preceptors and the senior guys they work with. When you learn a trade, the authority is in experience. When you are a professional, you learn from the science and theory of whatever it is you're learning.

I see this extreme well represented in the fire service as well.

It's not ever as simple as "if this, do that." There should always be some thinking applied to the problem.

Heck, I had a narc overdose this week that I chose just to manage the airway of and not give Narcan because of his extended down time and the associated pharmaceuticals he also indulged in. He was nicely anesthetized, why mess with that?

 

[Doczilla]

That's so rare and beautiful, this common sense.

Some firefighters tube, (then carve another "tube" notch with their Smith and Wesson jackhawk 9000 knives) , then give narcan anyway.

"Hey, can you hand me tape----"

(Patient) "mmmmfffff!!! BLAAAARGHHHH"

"He's buckin' the tube' Git the etomidate!"

 

[leoemt]

Why would you board this patient? Are you seeing any sort of obvious injuries that would make you think it should be considered?

Does he need bagged? What is his respiratory rate and effort? What's his airway like? Is it clear, or do you need to suction?

OP sounds like a student. In EMT class and in many protocols they teach to board and initiate spinal precautions for an unresponsive person when no one is around to tell you what happened.

If the kid's collapse was unwitnessed then back boarding would be appropriate.

 

[Asclepius911]

LA county is always on scene first, if they aren't first on scene and we are closer they will make us post near the scene till we get approval to show up

 

[NYMedic828]

OP sounds like a student. In EMT class and in many protocols they teach to board and initiate spinal precautions for an unresponsive person when no one is around to tell you what happened.

If the kid's collapse was unwitnessed then back boarding would be appropriate.

Not to criticize you, because this is absolutely what they preach be it wrong or right, but as a general point to this thread:

A picture is worth a 1000 words. I don't always need someone to blatantly tell me what happened.

 

[Melclin]

(EDIT): Redacted. I'm too young to have a stroke. I'm not ganna get involved.

(EDIT#2): Just one point to add. Seriously, you've presumably all been out on the turps. How many times have you been/been with mates who were semi conscious/lying on the ground/fell over drunk. If your first thought was that you/they needed spinal precautions until they got CT'd and not that you should shave one of their eye brows off, then I'm here to tell you that you're doing it wrong.

 

[Veneficus]

A picture is worth a 1000 words. I don't always need someone to blatantly tell me what happened.

I always love to ask what happened.

Not because I need anyone to tell me, because people come up with the most amazing lies ever.

"How did you do that?"

is usually followed up with:

"would you like to revise your statement?"

 

[abckidsmom]

I always love to ask what happened.

Not because I need anyone to tell me, because people come up with the most amazing lies ever.

"How did you do that?"

is usually followed up with:

"would you like to revise your statement?"

My favorite is "what made you decide that was a good idea?" When you get something other than I don't know, it's hillarious.

 

[msaver]

Okay you suspected a spinal injury, so you would never do the head chin tilt. Do jaw thrust. And you would only bag the guy if his breathing was inadequate.

 

[NYMedic828]

Okay you suspected a spinal injury, so you would never do the head chin tilt. Do jaw thrust. And you would only bag the guy if his breathing was inadequate.

Did you read any of the thread

 

[Veneficus]

Okay you suspected a spinal injury, so you would never do the head chin tilt. Do jaw thrust.

Never say "never" in medicine.

If you cannot maintain an airway with a jaw thrust, then you should do a head tilt chin lift.

A patient may have a spinal injury (unlikely) but they will certainly die without an airway.

 

[shiroun]

Never say "never" in medicine.

If you cannot maintain an airway with a jaw thrust, then you should do a head tilt chin lift.

A patient may have a spinal injury (unlikely) but they will certainly die without an airway.

x2. Life over limbs. Anyone who says never for head-tilt on a spinal injury has never tried a modified jaw thrust. that does NOT get any amount of air in, even with bagging. Gastric distension will occur quite a bit with it.

Also, do you really want to backboard an unconscious patient who may be etOH? Think about this. IF he vomits, you have to tilt the entire board, and he may aspirate before you do that. C-collar, fine. But boarding? Cmon now.

 

[Tigger]

x2. Life over limbs. Anyone who says never for head-tilt on a spinal injury has never tried a modified jaw thrust. that does NOT get any amount of air in, even with bagging. Gastric distension will occur quite a bit with it.

Also, do you really want to backboard an unconscious patient who may be etOH? Think about this. IF he vomits, you have to tilt the entire board, and he may aspirate before you do that. C-collar, fine. But boarding? Cmon now.

Someone in a c-collar is still at significant risk of aspiration if they vomit and are supine. They will still need positioning assistance should they begin to vomit, which may be easier to achieve if the patient is on a board and can be moved as a unit. If you let them roll themselves over there is no reason to have even put them in a c-collar because it is doing absolutely nothing for them once they manipulate themselves to vomit "normally."

As for the jaw thrust, I've used it before and was able to bag the patient for a time but the amount of neck extension required to do so seems like it may have negated any benefit should the patient had c-spine issues. We're only doing it because the hallway was too small for two people to be next to the head.