Jump to content


Photo
- - - - -

Case #47 The Medical Train Wreck


  • Please log in to reply
109 replies to this topic

#101 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 15 March 2009 - 06:09 PM

post self deleted due to computer illiteracy...
  • 0

#102 SerendepitySaki

SerendepitySaki

    Advanced Member

  • Members
  • PipPipPip
  • 1176 posts

Posted 15 March 2009 - 06:11 PM

good stuff Mike...THANKS! and you're absolutely right...even though there are many many vasoactive, sedatives, and opioid drugs I do EXACTLY what you said, I would have NEVER thought to do this with Narcan.... I too, dove for the .4 mg, hook, line and sinker.....I'm usually trying to completely reverse respiratory depression....nicely illustrated and duly added to my toolbox! VERY smooth! Thanks!!!!!


  • 0
LET THE WILD RUMPUS BEGIN !!!!!!
Sean G. Smith, RN-Alphabet Soup

#103 Mike MacKinnon

Mike MacKinnon

    Advanced Member

  • Members
  • PipPipPip
  • 920 posts

Posted 17 March 2009 - 09:14 PM

Ok a couple CC of narcan in pt is now breathing


His vitals are: BP: 110/69 HR: 94 Sat: 89% on a NRM


Are we off the ground yet?
  • 0
Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#104 rfdsdoc

rfdsdoc

    Advanced Member

  • Members
  • PipPipPip
  • 129 posts

Posted 17 March 2009 - 09:59 PM

yeah okay, load and go.

We know now that oral intubation or supraglottic devices are a no go so it is either through the nose or the neck to secure an airway if he loses it.

We know we can BVM successfully.

I agree with GILA. get going and come what may at altitude.
  • 0
Minh Le Cong
Medical Officer
MBBS(Adelaide), FRACGP, FACRRM, FARGP, GDRGP, GCMA
RFDS Cairns base , Queensland, Australia

#105 Mike MacKinnon

Mike MacKinnon

    Advanced Member

  • Members
  • PipPipPip
  • 920 posts

Posted 17 March 2009 - 10:10 PM

Awesome ;)

This was a case I adapted from an OR one that went really REALLY badly.

Essentially, the pt was inducted with VECC and propofol. Pressure dumped and pt had ST depression (significant), Turns out pts mouth would NOT open wide enough to intubate or use any devices. Pt was masked for the case (basically BVM with gasses).

The moral of the story is that if a pt cannot be intubated there is nothing wrong with BLS'in the airway. Why risk anything dangerous or stay and play too long?

Great job all!!
  • 0
Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#106 Speed

Speed

    Advanced Member

  • Members
  • PipPipPip
  • 1100 posts

Posted 17 March 2009 - 11:45 PM

Turns out pts mouth would NOT open wide enough to intubate or use any devices


Not even a scope?
  • 0
Mike Williams CCEMT-P/FP-C

#107 EDMEDIC

EDMEDIC

    Advanced Member

  • Members
  • PipPipPip
  • 94 posts

Posted 31 March 2009 - 04:53 PM

Great case and a good lesson Mike! Thanx, Brian
  • 0
Brian EMT-P/CC
"failing to prepare is preparing to fail"
" you don't know what you don't know"

#108 Mike MacKinnon

Mike MacKinnon

    Advanced Member

  • Members
  • PipPipPip
  • 920 posts

Posted 31 March 2009 - 04:59 PM

Not even a scope?



Nope.. it was terrifying.
  • 0
Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#109 MSDeltaFlt

MSDeltaFlt

    Advanced Member

  • Members
  • PipPipPip
  • 559 posts

Posted 31 March 2009 - 06:02 PM

Nope.. it was terrifying.


Dayam!!!
  • 0
Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#110 EDMEDIC

EDMEDIC

    Advanced Member

  • Members
  • PipPipPip
  • 94 posts

Posted 16 May 2009 - 02:03 PM

lokking forward to the next case! Hoping it's coming SOON! Brian
  • 0
Brian EMT-P/CC
"failing to prepare is preparing to fail"
" you don't know what you don't know"