• Scene – assess
• En route – vitals, IV, Fluids, trendelenberg, CBG, TT
• Unknown
• Elliot Williams, Paramedic Woodburn Ambulance
• David Tauber, EMT Editorial Board
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• IV placement
• Diarrhea
• Diarrhea
• Hypotension
• Dehydration
• GI bleed (upper vs. lower)
• Patient states – He can’t control his bowels and would like to be evaluated. He’s been having diarrhea today; no blood, just brown and runny.
• Rectal pain, hypotension
• GCS – 15
• EKG – First degree AV block
Three points around this student case to consider: 1) put chux (blue pads) in your IV start kit. Then if you are starting the IV on your lap it keeps your uniform from blood contamination. In the dirt it gives a clean starting field. In the house it keeps the furniture clean (which even if you save their life they will complain about messiness to the service chief). 2) The cleaning of the pts arm was at best poor. Use of only one cleaning pad, going back and forth over the same spot, palpating the cleaned area with exam gloves, and starting the IV lower than the that was actually the area cleaned. 3) awareness of a steroid in the med list and the possibility of causing fragile veins
~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital
• Gender: Male
• Age: 84 years
• Height: Not Available
• Temperature: 97.4 F/36.3 C
• Blood Pressure: 81/39
• Heart Rate: 70
• Respiratory Rate: 16
• Pulse Oximetry: 98%
Back pain; hip pain; diarrhea; rectal pain
• PMH: COPD, HTN, asthma
• Allergies: None
• Dispatch info: Back and hip pain
• Lives alone his sister lives near by, and they check in with each other every day.
• ASA, vit D, lisinopril, Plavix, doxazosin, metoprolol, atorvastatin, spriva, albuterol.
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