Vented Patients
Paramedics – If you have a patient who is special needs and on a vent at home and needs to be transported to the hospital, and the parents and\or home health aide\nurse have and is specifically versed in the portable vent’s workings, please let them transport the patient on their vent. If possible, allow the parent, or healthcare aide to accompany you in the back of the ambulance to assist and monitor the patient on their equipment. They are familiar and knowledgeable about that specific vent, the patient, and the patient’s suctioning equipment and can be a great asset. This isn’t about you, but about the patient, and this can be best patient care. It’s understood that if the patient is in extremis or unstable, that that’s your specialty, but if not, just be a supportive and watchful eye.
Bradycardia
We had a very lethargic and slightly altered patient which according to the family was progressing very slowly over the last few days. He was alert and answering basic questions but confused on more complicated ones. He was warm dry and of good color, no resp distress, clear bilaterally, no noticeable neural deficits, couldn’t confirm any changes in urine output, color, or smell. No noticeable trauma. Was incontinent but no oral trauma and no history of seizures. No smell ETOH and no drug history. Pupils slightly pinpoint but once again no history of drug abuse and not on any pain killers. Heart rate was 30 on a consistent junctional rhythm, SPO2 100%, and blood pressure surprisingly 144/67 with no signs of cardiac compromise. BGL within normal range. 12 lead unremarkable. Pt was not complaining of any chest pain or other distress. Had a history of hypertension. What do you think is going on?
Given the potential for medication overdose, we potentially suspected beta blocker overdose but also considered electrolyte imbalances. We considered the potential treatment modalities glucagon, atropine, push dose epi, pressors, pacing, etc., but the patient had no cardiac compromise and without complaint. Consulting with Medical Control up and above our standing order protocols, we were given a slew of PRN medications and procedures for potential deterioration and away we went to the hospital. The patient remained stable without change the whole way to the hospital. What was it?
Later we found that it was hypothermia. Never would have thought that. Patient did not feel overly cold, was sitting in a warm environment when found, had not been outside in days, but that was the cause. Interesting.