Читать книгу Clinical Cases in Paramedicine - Группа авторов - Страница 343

The son states that the patient has not been well lately. His medical history includes diabetes, hypertension, hypercholesterolemia and end‐stage renal failure. They used to use home dialysis, but for the last two months he has had to go to hospital as his condition has worsened. For the last week he has not been to the hospital as he has been too unwell and hates hospitals. Last night he was not well and had a restless sleep. He said his heart was racing, but didn't tell anyone until this morning. He has been in bed since as he told them his muscles were aching and tingling. When they checked on him they found him unconscious with vomit in the bed.

1 Describe your primary survey for this patient.Danger: No danger.Response: None.Circulation: No pulse, commence CPR and remove any clothing on patient’s thorax area and place the defibrillation pads and analyse rhythm, shock if advised.Airway: vomit is present, requires suctioning that clears airway.Breathing: No breaths.

2 Describe how you would manage your crew and others on scene. What roles would you allocate and would an early sit rep be of benefit?As lead paramedic you should allocate roles and ensure they are maintained. As airway clinician you should assist with removal of clothing and placement of the defibrillation pads onto the patient’s chest to ensure quick automatic analysis of the rhythm. The son is performing quality compressions, so asking him to assist and continue would be appropriate if he is willing. Compressions can then be managed by your partner.The airway then needs to be cleared with suctioning and a correctly sized OPA placed (describe your sizing technique). Then you need to ensure the ratio of 30 compressions to every 2 breaths is maintained and the rate is between 100 and 120 bpm, with appropriate compression depth (1/3 of chest wall). Rhythm checks completed every 2 minutes.An early sit rep is vital in any high‐acuity case. In this case a request for another crew to assist with resuscitation would be appropriate, as would a request for an intensive care paramedic.