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Scenario #1 (MI) 65 yo male sitting in a chair at home c/o “I’m not feeling well”. Upon asking these are the answers: Abdominal pain (really chest pain) Cool, pale, slightly moist skin Only medication is Zantac No allergies No SOB No previous cardiac history “I’ve had trouble walking the last 3 days” Vital Signs P: 90 BP: 170/80 RR: 30 Critical activities Where does it hurt? Probe “trouble walking” V/S including RR O2 06/29/17 Page: 1 Scenario #2 (A.P.E.) 72 yo alert male lying on his back c/o “I can’t breath” Upon asking these are the answers: I’ve been sleeping with extra pillows the past 2 nights Swollen ankles Medications: Furosemide, Lanoxin, Nitro, Vital Signs P: 130 BP: 220/110 RR: 36 and very labored Skin: cool, pale, dripping with sweat Now the patient starts becoming lethargic New v/s: P=130, BP=220/110, RR=18 and less labored Critical activities Sit pt up O2 Call for ALS Monitor v/s Monitor Level of Consc. BAG patient once LOC starts dropping What to do if no ALS available? 06/29/17 Page: 2 Scenario #3 (GI bleed, hypovolemia) 33 yo lying in bed c/o abdominal pain for 2 days Upon asking these are the answers: Taking aspirin for knee pain from recent surgery No prior medical history Dark stools for last 3 days Distended abdomen Denies other complaints pt. becomes very dizzy when he stands up Vital Signs Lying in bed P: 100 BP: 130/70 RR: 26 Standing up P: 120 BP: 100/60 RR: 26 Critical activities Take orthostatic vital signs Call for ALS Shock position O2 06/29/17 Page: 3 Scenario #4 (Insulin “shock”) 50 yo male found by wife (after coming from work) lying in bed face down. She can’t wake him up. Upon asking these are the answers: Breathing, with a snoring sound Sweating profusely, pale Diabetic history, some heart problem Hasn’t been eating well lately No recent history of trauma Medications: Insulin, cardizem Call for ALS: NO ALS available Vital Signs P: 48 BP: 100/60 RR: 18 and snoring loudly Critical activities Question wife if he’s a diabetic Did he eat today? PROTECT THE AIRWAY Monitor vital signs, treat for shock if BP drops (maybe another problem as well) DO NOT GIVE ORAL GLUCOSE Rapid transport Call in a standby 06/29/17 Page: 4 Scenario #5 (MI) 80 yo male clutching his chest complaining of severe chest pain Upon asking these are the answers: Was awoken from sleep by pain Radiating to both arms Having some trouble catching my breath I feel like vomiting Nothing relieves the pain Did not take nitro I have some heart problems Sometimes when I walk steps I get some chest pain Medications: Nitro pills, Nitro patch, Lasix, Cardizem Dripping wet from sweat, anxious, Vital Signs P: 100 BP: 180/70 RR: 30 Critical activities O2 Call for ALS Help pt. take their own nitro tabs 06/29/17 Page: 5 Scenario #6 (Exacerbation of COPD) 72 yo male sitting at the edge of his bed c/o SOB, very agitated. There is a large O2 tank in the room. Upon asking these are the answers: I smoked 2 packs a day for 45 years I always have some SOB, it’s been getting worse the past few days I use O2 in my nose when I need it I’ve had a chest cold the for 3 days Wheezing (you can hear it without a stethoscope) Medications: O2, Proventil, some other inhalers, Theophylin, Medrol pt is very agitated, but starts to calm down and become sleepy and yawns a few minutes after you start O2 You no longer hear wheezing, upon auscultation the lungs are “quiet” No other history Vital Signs P: 160 BP: 164/86 RR: 40 Critical activities High Con O2 Monitor level of consciousness Bag the patient when they start becoming sleepy (yawning is a warning to look for) Call for ALS The patient continues to lose consciousness and becomes unresponsive Answers to questions Not breathing No pulse ALS has an extended ETA Critical Activities ABC’s SEMIAUTOMATIC DEFIBRILLATOR!!! CPR 06/29/17 Page: 6 Scenario #7 (TIA/CVA) “I woke up this morning with a terrible headache and I can’t get out of bed” Answers to questions: I can’t lift my leg No recent trauma Hypertension history – I don’t take the medication because it makes me sick No allergies Vital Signs P: 120 BP: 230/140 RR: 24 Critical activities O2 Monitor v/s Monitor for loss of airway Transport without delay – no sirens 06/29/17 Page: 7 Scenario #8 (Hematoma in the brain, secondary to head injury) You find a semiconscious 51 yo male lying prone on the floor. There is a small cut on his forehead that looks a few days old. Answers to questions: Witness: “He fell off a ladder 3 days ago. “ No other medical history known Large hematoma on his forehead Vital Signs P: 64 BP: 240/120 RR: 8 Snoring loudly Critical activities While holding traction at the C-spine, log roll the person on to back Stabilize the C-Spine with collar Call for ALS (no ALS is available) Airway control (Oral Airway, BVM) Long Board Monitor v/s Transport (to trauma center) 06/29/17 Page: 8 Scenario #9 (Hip fracture, complicated by extensive cardiac history) “I fell and I can’t get up” Answers to questions: 80 year old female No Loss of consciousness, dizziness, chest pain before or after the fall I heard a crack in my thigh and then I fell Terrible pain in my outer right thigh Mechanism of injury implies no C-spine injury Right leg appears shorter than left Very swollen ankles, bilaterally Medications: Lasix, Isosorbide, Nitro tablets, Lanoxin, Cardizem, Norvasc, Vasotec Allergic to demerol (I break out in hives) History: 3 MI, CHF, Hypertension, irregular heart beat Vital Signs P: 120 BP: 180/90 RR: 24 Critical activities Monitor v/s Splint and board O2 (given the medications and apparent history) Don’t transport to Joint! Notify hospital of Demerol allergy (very commonly used painkiller) 06/29/17 Page: 9 Scenario #10 (Anaphylaxis) “16 YO male: My tongue feels funny” Answers to questions: This happened any time I eat fish Skin: “Red bumps all over my skin” Having problems breathing and it’s getting worse “No medications, except something that I stick in my thigh” “I used it a few weeks ago and forgot to replace it” Vital Signs P: 130 and thready BP: 100/60 followed in 5 minutes by 80/40 RR: 36 and very labored Critical activities Sitting position O2 at highest concentration Call for ALS Rapid transport to closest hospital BVM, should the pt begin to lost consciousness 06/29/17 Page: 10