What would you do in this situation?

CaptainPanic

Former EMT...
560
0
0
It is 6pm and you and your station crew are sitting down to eat a nice meal, when suddenly you are dispatched to SMITTYS GROCERY.

According to the dispatch report there is a 16 year old girl who has gone through the grocery store eating everything off the shelves, and the police have stated that she looks gravely malnourished, and are guesstimating her weight to be less than 70 pounds.

You and your mate take the call thinking this is likely a psych call with a possible history of anorexia and schizophrenia.

You arrive on-scene to see this 16 y/o female huddled in the back of the patrol car with a thick blanket covering her. She appears frieghtened and scared.

You extend your hand out and introduce yourself as a Paramedic and you have been called to take her to the ER for an evaluation on her health. At first she just looks at you then she takes your hand as you help her out of the patrol car, her hand is like ice to the touch.

Once inside the rig, under the light she looks very pale, with bones jutting out at every point, you turn the pt. compartment heater on although it is 65 degrees outside. You guesstimate her weight to be 50 pounds.

You go through your SAMPLE history
Signs/Symptoms - Feels cold, pain in her abdomen, weakness, dizziness, significant loss of muscle mass.

Allergies - none

Medical history - no history of mental disorders related to anorexia or others, and no medical condition to cause loss of muscle mass such as parkinsons or MS.

Past Pertinent history - she tells you that she and her 11 year old brother have been locked in a bathroom for 5 years and were allowed to eat only every few days. There are other well-cared for children in the house as well.

Last oral intake - before the grocery spree she states it has been almost a week since she last ate, and it was a small bowl of dried cereal which she shared with her brother.

Events leading to incident - Her grandmother had come to go the bathroom, which she pushed out of the way to escape and she ran to the grocery store to find some food to eat.

You take her V/S as follows-
BP - 80/56
Pulse - 53
Resps - 22
Pulse Ox - 88%
Capillary refill - slow
Skin - pale, cold, dry to touch
pupils - slow, but reactive

What is your treatment for this girl, and what would do in this situation? Do you suspect abuse? Do you suspect undiagnosed mental disorders? Would you notify authorities?

:unsure:

-CP
 

FFEMT1764

Devil's Advocate
565
2
0
I would absolutely transport the girl to the ER, start IV fluids enroute...heated humidified o2, and warm her up with hot packs and blankets....when i get to the ER i would tell the doc's about what she told me, document it in my report, and notify the police, dss/dcf/etc...about this info too.
 

rescuecpt

Community Leader Emeritus
2,088
1
0
O2 to bring up SpO2. IV NS @ KVO for dehydration and to raise BP. Resps and pulse are ok, and both should stay the same or become stronger w/O2 and IV. Warm her with blankets and heat in the ambulance, but be careful not to overheat her (especially because she is dehydrated). I would say RLS to hospital since someone who is malnurished usually does not react well to large quantities of food.

Also, DEFINITELY report to social services, police, etc. In NYS you are required to report if you suspect abuse or neglect in the least - and based on this girl's age and weight, you have very strong reasons to suspect. Even if her story is bull, no 16 year old should weigh 50 - 70 pounds, even if she did this to herself (anorexia, bulemia), social services needs to be involved.
 

rescuecpt

Community Leader Emeritus
2,088
1
0
FFEMT1764 said:
I would absolutely transport the girl to the ER, start IV fluids enroute...heated humidified o2, and warm her up with hot packs and blankets....when i get to the ER i would tell the doc's about what she told me, document it in my report, and notify the police, dss/dcf/etc...about this info too.

NYS pulled hot packs out of our inventories and protocols - they have found that rapid rewarming is dangerous - pt's end up burned and with other complications, but I've heard debates on both sides about this.
 

emtbuff

Forum Captain
490
0
0
If your a I of P squad start a line of fluids I would probley TKO or a slow drip not knowing how it would affect the cardiac status she has as if she really has been locked in the bathroom and not eating she may be dehydrated. Start some O2 I think I would use a NC at 2-3 and recheck pulse ox increasing O2 as needed to increase O2 sat.

As for the possibility of abuse I would report it to the authorities, hopefully since she is 16 she can tell you where she lives or enough of a location so the Law enforcement officials can go in and just check on things. As she seems scared of adults at first so it is possible that there is abuse in the family or house hold so it needs to be checked out. Obviously if her story true there could be another child that is being injured or neglected. Remember we are mandatory reporters its one of the many hats that we wear.

If the pt looks that neglected there is the possibilty that she could have a undiagnosed mental illness but remember the parents may know about the mental illness and couldn't handle it or so forth so they locked her up maybe the brother has the same thing wrong and that is why they are both locked up. Got to remeber that parents reach there extremes and can't handle thing like they use too and that can lead to severe problems. Or there is the possibility of the parents having mental illness also.
 

FFEMT1764

Devil's Advocate
565
2
0
rescuecpt said:
NYS pulled hot packs out of our inventories and protocols - they have found that rapid rewarming is dangerous - pt's end up burned and with other complications, but I've heard debates on both sides about this.

Our state lets us use them...we just place them in towels and on top of blankets- never direct skin contact...and it helps alot...
 

Ridryder911

EMS Guru
5,923
40
48
I agree with most of the other post.. I too be cautious of bolus fluid. Anorexic pateints have a high tendency to go in to Frank CHF with fluids ( remember the singer Karen Carpenter?). Of course social services will be involved. Maintian bofy warmth.. again, this is long term physical response not acute hyporthermia. ( shame of emoval heat packs ... idiots not using padding between them) ...

Be safe,
R/R 911
 

daemonicusxx

Forum Lieutenant
131
0
0
i agree with everyones treatments, definatly would be documenting and reporting, tell us what happened????? we're curious!!!
 

TTLWHKR

Forum Deputy Chief
3,142
5
0
Wrap the IV line w/ several hot packs.

Don't have them? Tie the IV bag to a ceiling rail w/ a tourniquet, near a heat vent. Point the vent at the bag, turn the temp set up to 85.
 

ffemt8978

Forum Vice-Principal
Community Leader
11,031
1,479
113
I agree with everything said already, except that since law enforcement was already involved our protocols are slightly different. We're required to notify law enforcement if they're on scene, and report that information to the hospital (including the officer's name). I would probably send a second rig to the house with law if they were going right away to check on the brother.
 

nyc.ems

Forum Crew Member
71
0
0
hey rescuecpt... we still have warm packs on our 911 ambulances.we have them in our rigs as part of our 800 inventory...
 

Jon

Administrator
Community Leader
8,009
58
48
I would go for re-warming... if VERY cool, I would use hot packs in core areas (armpits, etc).. also cover the Pt's head with a towel (we lose most heat through the head). ALS wise - start IV, NSS TKO, poss. use warmed solution. Consult with Command on Fluid Bolus...

Before you transport... speak with Law Enforcement, let them know what the patient is saying - perhaps the LEO's don't have that story yet... if they are going to the house... suggest they have another EMS unit stage for them. Contact your Supervisor, have him either respond to the scene or meet you at the ED. Advise Command of the situation when you consult for the fluid bolus... perhaps the ED will want an extra room... definalty will want the ED social worker to be in the loop from square one... you either have a REALLY mentally-messed-up kid, or a BIG blatene case of abuse/neglect.

Oh... and I shouldn't have to say it... document the heck out of this case... including any CYF abuse reports...

Jon
 

rescuecpt

Community Leader Emeritus
2,088
1
0
nyc.ems said:
hey rescuecpt... we still have warm packs on our 911 ambulances.we have them in our rigs as part of our 800 inventory...

Are you in NYC? They have their own set of rules...

This is weird... I just looked, the 2003 BLS protocols have heat pack in it - I could have sworn the State was the reason we stopped, I guess it was Suffolk County - neither of my squads have it and I'm pretty sure none of my fiance's squads have it either. When CVAC took it out I was told it was because it was no longer in our protocols... I know there's a BLS rollout right now mainly about the updated RMA forms, but maybe that's in there too.

BUT, I double checked Part 800 - search it for "heat", "hot", or "pack"... all you come up with is a requirement for 4 cold packs.
http://www.health.state.ny.us/nysdoh/ems/part800.htm
 
Last edited by a moderator:

coloradoemt

Forum Asst. Chief
616
2
0
This is deffinately a situation where no matter where you live and what your protocols are, documentation needs to be overly detailed as well as descriptive.
 

emtd29

Forum Lieutenant
133
0
0
rescuecpt said:
This is weird... I just looked, the 2003 BLS protocols have heat pack in it - I could have sworn the State was the reason we stopped, I guess it was Suffolk County - neither of my squads have it and I'm pretty sure none of my fiance's squads have it either. When CVAC took it out I was told it was because it was no longer in our protocols... I know there's a BLS rollout right now mainly about the updated RMA forms, but maybe that's in there too.

BUT, I double checked Part 800 - search it for "heat", "hot", or "pack"... all you come up with is a requirement for 4 cold packs.
http://www.health.state.ny.us/nysdoh/ems/part800.htm




They might have been removed as part of Suffolk's REMAC Protocols even though the state still has them in protocol

We Don't have them here in Nassau County either
 
Last edited by a moderator:

rescuecpt

Community Leader Emeritus
2,088
1
0
emtd29 said:
They might have been removed as part of Suffolk's REMAC Protocols even though the state still has them in protocol

We Don't have them here in Nassau County either

Cool, so I'm not crazy. At least not any more than usual. ;)
 
Top