January 28, 2011

What Would You Do?

Quick little scenario:

Call for respiratory distress. On arrival, you can hear coarse sounds across the room. Patient has accessory muscle use of the SCM. Coarse crackles in ALL lung fields.
Respiratory rate of 50-60/min
BP- 80/30s
HR- 110-120s, sinus rhythm w/o ectopy
Spo2 going from 99% to 93% despite being put on a non-rebreather.
EtCO2 of 5 with good square waveforms
GCS of 3-4 (pt opens eyes, but you'd be hard pressed to say it's "spontaneous").

No history of respiratory problems, had a CVA a few weeks prior, and has Hypertension

Per nurse, patient had vomited just prior to your arrival but no secretions spotted. In the ambulance, both you and your parter cannot get an IV despite multiple attempts.

Let's just say it screams "sepsis", with the stupidly-increased ventilatory rate most likely a compensatory mechanism for the metabolic acidosis.



You're 15 minutes from the hospital. What do you do?
Now you're 45 minutes from the hospital. Change your plan?



IO and RSI?
IO and Etomidate (forgo the paralytics)
OG/NG tube?
Or haul butt to the hospital?

January 17, 2011

Yeah... Right

So, you know when you get a stabbing victim and to protect someone they say "No one stabbed me, I fell on the knife"?


Yeah, I think this one actually fell. Odd. Guess a couple of marijuana blunts and a Forty will do that to ya!




Ahhh EMS.

January 7, 2011

Chest Pain Magnet

I must be a chest pain magnet... that is the only explanation. Every shift, without fail, atleast 50% of my calls are "chest pain", yet they are never the same presentation, and that is what I love about medicine.

Some are classic angina. Some are acute MIs. Some get toned as chest pain, and it ends up being the kidneys. But each one, while the same, is also different.

Last shift I had two actual STEMIs, one getting a nitro drip (which I love... even if it is math), though neither met criteria to do a Code STEMI activation.


And the shift before that, I actually had an NSTEMI, which I got to see progress from just 2 leads, through nearly all of them. The patient SHOULD have been flown from the scene, but dispatch didn't dispatch the helicopter, even though it met auto-launch criteria. We got to the ED, the doc (my medical director) looked at my progressing 12-leads (was happy that I did right-sided 12s as well), called in to the cath lab, and off the patient went.