Download Critical activities

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
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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
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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
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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
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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
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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