DECEMBER 2015 CASE STUDY

You and your partner are working in an urban ALS service and are dispatched to a cardiac arrest at a private residence. On arrival to the scene, the fire department is breaking down a door into an upstairs bathroom. Patient’s wife states that she and the patient, a 25YOM, fell asleep together around 2000; she states that she woke up at 2045 to find the patient had left the bedroom; the upstairs bathroom door is locked, and the patient is not responding while the patient’s wife or fire department is calling out for him. According to the wife, the patient has not taken his Prozac in over two weeks. Crews break down the door to find the patient naked, covered in vomit, and alert to loud verbal stimuli. No obvious signs of trauma, drug paraphernalia, medication bottles, or alcohol noted.

ASSESSMENT

  • Patient is a GCS of 11
    • Opens eyes to verbal commands
    • Inappropriate answers to questioning
    • Localizes pain
  • Respirations appear within normal rate, shallow
    • L/S are clear= in the upper lobes w/coarse rhonchi in the lower lobes
  • Strong/Regular radial pulses noted
  • Skin is hot, flush, and diaphoretic
  • Pupils are fixed and dilated

VITAL SIGNS

  • BP: 124/76
  • HR: 64/regular; NSR on the monitor w/no ectopy or ST abnormalities
  • BGL: 113 mg/dl
  • RR: 12/shallow
  • SpO2: 97% on R/A

Any considerations for specialty hospitals?

Where would you start with your treatment?

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