Go Back   Professional Soldiers > TMC 14 > Medical Pearls Of Wisdom

Reply
 
Thread Tools Display Modes
Old 11-14-2014, 17:33   #1
Sdiver
Area Commander
 
Sdiver's Avatar
 
Join Date: Feb 2004
Location: The OTHER Mile High city ... with Mtns on the East side
Posts: 5,893
Medical Scenario V

Alright, let's get these scenarios back up and running ....


You respond on a respiratory emergency and find a patient unresponsive at a local restaurant. Bystanders are performing CPR.

They report to you that the patient started choking and attempts at the Heimlich were unsuccessful.

The patient has extremely labored, shallow, stridorous agonal respirations. He is cyanotic. There is a palpable carotid pulse. It is extremely difficult to ventilate the patient via BVM.

You grab a laryngoscope, visualize the cords, and see the following ...

What are your next steps in patient care and stabilization?


Other thoughts/considerations?
Attached Images
File Type: jpg Cords.jpg (11.6 KB, 175 views)
__________________
Non Sibi Sed Suis
_____________________________________________
It's Good To Be Da King !!!! Just ask NDD !!!!
Sdiver is offline   Reply With Quote
Old 11-15-2014, 04:42   #2
NurseTim
Guerrilla
 
Join Date: Feb 2011
Location: NM
Posts: 445
If you have a scope you likely have Mcgills as well. Latch on and remove. Failing that, continue to ventilate, you did say it was difficult, not impossible. Failing that, needle cric.
NurseTim is offline   Reply With Quote
Old 11-15-2014, 11:09   #3
miclo18d
Quiet Professional
 
miclo18d's Avatar
 
Join Date: Mar 2012
Location: Tampa, FL
Posts: 1,543
^^^ this plus O2.
__________________
"The rifle itself has no moral stature, since it has no will of its own. Naturally, it may be used by evil men for evil purposes, but there are more good men than evil, and while the latter cannot be persuaded to the path of righteousness by propaganda, they can certainly be corrected by good men with rifles." Jeff Cooper
miclo18d is offline   Reply With Quote
Old 11-15-2014, 16:29   #4
Trapper John
Quiet Professional
 
Trapper John's Avatar
 
Join Date: Nov 2012
Location: Harrisburg, PA
Posts: 3,455
Do I have a cricothyrotomy kit? If not I improvise. Use the oropharyngeal airway to support the opening and pass O2 through a cannula. Transport to the hospital for extraction of the foreign body or surgical repair of the trachea as the case may be.
__________________
Honor Above All Else

Last edited by Trapper John; 11-15-2014 at 16:31.
Trapper John is offline   Reply With Quote
Old 11-16-2014, 14:10   #5
Stephens
Asset
 
Join Date: Sep 2014
Location: North Texas
Posts: 10
I just want to say that some of you exhibit better clinical reasoning than more than a few Nurse Anesthetists, Anesthesiologists, PAs and ICU docs I've seen attempt airway rescue.

I won't say what I would do as it has already been posted (twice).

ETA: Also, remember, at this point you have a free hand to feel the anterior neck and possibly improve your view while also assessing.
__________________
Panem et Circenses

Last edited by Stephens; 11-16-2014 at 14:14.
Stephens is offline   Reply With Quote
Old 11-16-2014, 16:04   #6
Sdiver
Area Commander
 
Sdiver's Avatar
 
Join Date: Feb 2004
Location: The OTHER Mile High city ... with Mtns on the East side
Posts: 5,893
Quote:
Originally Posted by DocIllinois View Post
I'm still wondering about level of training.
Current level of training is what YOU are currently at ... EMT Basic, Advanced, Paramedic, RN, PA, MD, etc ....

Take the scenario for what it's worth.

"YOU respond on a respiratory emergency and find a patient unresponsive at a local restaurant." ... meaning that you are on a first response vehicle, with the appropriate ALS stocked bag(s).

The fact that YOU "grab a laryngoscope, visualize the cords ..." tells that this is an advanced airway procedure, so this would RO Basics and Advanced EMTs.

Don't READ into the post or the picture too much. This scenario is very much seen and any subsequent Tx is within the scope of first-responders (Paramedics and above).

Yes, knowing what the Pt. was eating is good to know, but looking at the picture and given that there is some, although minimal, air movement, it very well could be an undercooked piece of elbow macaroni.

Not only did I post this for training purposes, but in a situation like this, there are inevitably two camps as for initial treatment.

.... and GO.
__________________
Non Sibi Sed Suis
_____________________________________________
It's Good To Be Da King !!!! Just ask NDD !!!!
Sdiver is offline   Reply With Quote
Old 11-16-2014, 17:58   #7
MR2
Quiet Professional
 
MR2's Avatar
 
Join Date: Nov 2011
Location: Location, Location
Posts: 3,799
Does he have a nice watch? Is there any unattended lobster or filet mignon?
__________________
The two most powerful warriors are patience and time - Leo Tolstoy

It's Never Crowded Along the Extra Mile - Wayne Dyer


I've always thought America was Great. Wouldn't it just be Great if we made it America Again?
MR2 is offline   Reply With Quote
Old 11-16-2014, 18:09   #8
Sdiver
Area Commander
 
Sdiver's Avatar
 
Join Date: Feb 2004
Location: The OTHER Mile High city ... with Mtns on the East side
Posts: 5,893
Quote:
Originally Posted by MR2 View Post
Does he have a nice watch? Is there any unattended lobster or filet mignon?
Tsk, tsk, tsk ... He's only MOSTLY dead, he's NOT all dead.
__________________
Non Sibi Sed Suis
_____________________________________________
It's Good To Be Da King !!!! Just ask NDD !!!!
Sdiver is offline   Reply With Quote
Old 11-16-2014, 18:51   #9
Trapper John
Quiet Professional
 
Trapper John's Avatar
 
Join Date: Nov 2012
Location: Harrisburg, PA
Posts: 3,455
Quote:
Originally Posted by MR2 View Post
Does he have a nice watch? Is there any unattended lobster or filet mignon?
You funny Petason!
__________________
Honor Above All Else
Trapper John is offline   Reply With Quote
Old 11-16-2014, 21:20   #10
RichL025
Quiet Professional
 
Join Date: Oct 2007
Location: San Antonio, TX
Posts: 377
Knife, please....

ie - he is already cyanotic and cannot ventilate with a BVM. He needs a surgical airway.
__________________
Ars Longa, vita brevis
RichL025 is offline   Reply With Quote
Old 11-17-2014, 06:45   #11
PedOncoDoc
Area Commander
 
PedOncoDoc's Avatar
 
Join Date: Oct 2009
Location: Northeast Utah
Posts: 1,672
Quote:
Originally Posted by RichL025 View Post
Knife, please....

ie - he is already cyanotic and cannot ventilate with a BVM. He needs a surgical airway.
I agree with RichL. I'm surprised there aren't more secretions with that obstruction - it's likely also obstructing the esophagus with how rigid it appears.
__________________
‎"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
PedOncoDoc is offline   Reply With Quote
Old 11-17-2014, 12:01   #12
CSB
Quiet Professional
 
CSB's Avatar
 
Join Date: Feb 2004
Location: Clarksville, TN
Posts: 1,112
Looks like half of a fortune cookie lodged in there.
Agree I'd grab it ASAP, before it softens up and drops into the trachea / lungs.
CSB is offline   Reply With Quote
Old 12-06-2014, 21:26   #13
Koldsteel
Asset
 
Join Date: Dec 2013
Location: Louisiana
Posts: 13
Im coming to this conversation late. But as a CRNA and an old street medic, I would remove the obstruction with the Magils and admin O2. Ive had this exact scenario once before.
Koldsteel is offline   Reply With Quote
Old 12-07-2014, 10:49   #14
NurseTim
Guerrilla
 
Join Date: Feb 2011
Location: NM
Posts: 445
Quote:
Originally Posted by Hopefully View Post
I'd attempt to remove it via suction. Should that work, I'd go for my second attempt at combitube insertion.
Why would you intubate after removal? Possible airway edema secondary to trauma?
NurseTim is offline   Reply With Quote
Old 12-15-2014, 21:58   #15
Koldsteel
Asset
 
Join Date: Dec 2013
Location: Louisiana
Posts: 13
Quote:
Originally Posted by NurseTim View Post
Why would you intubate after removal? Possible airway edema secondary to trauma?
Airway edema is surely possible and if the obstruction is complete, negative pressure pulmonary edema is possible. If the patient is tolerating my laryngoscope then he will tolerate the ETT. I can always extubate later.
Koldsteel is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump



All times are GMT -6. The time now is 14:04.



Copyright 2004-2019 by Professional Soldiers
Site Designed, Maintained, & Hosted by Hilliker Technologies