Emergency Dept Case StudiesEmergency Dept Case StudiesChange in MSChange in MS

You receive a call on C-med radio- 5-minute ETA with a 32 yo male found in his car, responding to painful stimuli only. Skin cool and diaphoretic. VS 90/p..HR 120..RR 12. What causes could be causing this patient’s unresponsiveness?

Hypoglycemia, drug/etoh overdose, CVA, seizure, head trauma

How would you prepare for this patient (including medications you anticipate this patient may receive)?

Notify ED attending, prepare for IV insertion and IVF (#18 or 16 if possible), check suction, EKG machine in room, glucometer in room.

Possible Meds? D50, narcan

Patient arrives, what 3 things must be assessed immediately?

ABC’s

Airway

Breathing

Circulation

What lab studies would you send on this patient?

SMA-7, CBC, toxic screen (serum and urine if possible). Possible ABG, Fingerstick

The FS was 107. The patient was given narcan with no improvement. The patient’s respiratory rate is 10, shallow. How would you prepare for intubation?

Make sure attending aware of patient status, notify respiratory therapy.

Open black intubation box in room and check contents. Prepare for Rapid Sequence Intubation.

Meds:

•Etomidate (20mg)

•Succs (100 – 140mg)

•Possible Lidocaine

•Follow up Fentanyl / Versed