Narritive 2

.pdf

School

National EMS academy *

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Course

ANATOMY1

Subject

Health Science

Date

Apr 3, 2024

Type

pdf

Pages

3

Uploaded by CountComputerCrab55

Report
C - Medic 37 is dispatched for an emergent response on Main Street at Main Street Grocery for a 50-year-old male who is experiencing rapid onset of shortness of breath. Lights and siren were used without incident or delay. Weather is warm and dry. Road conditions are dry. Arrival to scene was without incident. H – Upon arrival, the male patient is found outside of the grocery store in a seated position. Patient is alert and oriented. Presently able to speak in full sentences but does have some visual respiratory distress noted. Accessory muscle use along with intercostal retractions are noted. Per patient, he states the shortness of breath was abrupt and started while inside of the store. Only reported past medical history is Congestive Heart Failure. Patient did not provide a list of medications and we are unsure of any drug allergies or adverse reactions. A – Initial rapid assessment reveals notable respiratory distress. Patient is alert, but visibly anxious. He follows verbal commands appropriately. Skin is pale and diaphoretic. It is noted that patient’s progression of symptoms is rapid and is having a notable decline in his condition. Initial baseline VS are obtained and as follows: BP 144/94, Respiratory Rate 28 labored, Heart Rate 120, SpO2 95% on 4lpm via NC. During assessment, patients condition continued to worsen. Dispatch was advised to start Fire Dept emergently to assist crew. Patient required manual assistance with airway management by use of BVM. Vitals reassessed: Patient responds only to painful stimuli, respirations 36 shallow. Lung sounds are positive for gurgling. Heart rate is 150 weak/regular, skin is pale and diaphoretic. Notable facial cyanosis present. BP 118/70, SaO2 86% (Assisting with BVM and supplemental 02). While enroute to ED, patient went completely unresponsive. At
this time, vitals were noted: respirations at 30 & shallow, heart rate of 160. Severe facial cyanosis. BP 98/58. SaO2 83% with BVM and 100% O2. R – Upon arrival, patient was placed on Oxygen at 4 LPM via nasal cannula with built in end tidal CO2 monitoring for dyspnea and acute respiratory distress. Due to a change in patients’ condition/status on scene, patient was assisted with ventilations using a Bag Valve Mask and supplemental oxygenation at 100%. IV access is obtained – 18 G in Left AC. 1 attempt. Patient is placed on cardiac monitoring and 12 lead EKG obtained and transmitted. Due to length of transport and patient condition, fire dept personnel is used to assist with loading and transport. Due to difficulty maintaining adequate seal and continued deterioration of patient, we elected to secure the airway via endotracheal intubation. Patient is given Ketamine IVP 2mg/kg (150mg total) and 50mcg Fentanyl IVP per standing protocol prior to intubation. An 8.0 ET tube was placed using a size 3 Macintosh blade. Vocal cords are visualized. ET Tube is secured, and capnography confirms successful placement. Lungs are auscltated in all fields. The ATV (automatic transport ventilator) is applied. Vitals are reassessed (BP 118/70, Respirations 12 d/t ATV settings, SaO2 97% with ATV and 100% O2, Heart Rate 118 strong/regular) patient’s condition is noticeably improving and cyanosis is rapidly dissipating. Patient is continually monitored for changes throughout transport. Radio report is provided to ED. No further orders received. T - Patient is placed on the stretcher and secured with straps x 5. Patient is supine due to deterioration of condition. Emergent transport to ED with the use of lights and siren. Patients condition rapidly declined from scene to transport as noted above. Fire dept personal was used to drive ambulance so both crew members were
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