Managing Crashing Patients in The Field

Strategies to Prevent Early Mortality Mark Pinchalk , MS, EMT-P  EMT-P  Paramedic Crew Chief  Pittsburgh EMS

Case Presentation 1 54 y/o female “severe respiratory distress” • Hx: COPD, HTN, Asthma • Vitals: • GCS = 15 • P: 140 • R: 48 • SpO2: 68% • BP: not documented • EKG: not documented

Case Progression 0000

Patient Contact

0002

Vitals

0006

CPAP – SpO2 70%

???

“pt was extric extricated ated from the house with extreme difficulty extreme difficulty due to pts respiratory status, obesity and confinements of pts residence”

0026

CPR Initiated

0027

EKG: sinus brady

0029

IO initiated

0030

EKG: asystole

0060

Arrived @ ED in Asystole

Case Presentation 2 75 y/o female c/o weakness: Hx: None Listed Vitals •

CAO, GCS = 15

•

P: 76

•

R: 20

•

SpO2: 97%

•

BP: 88/64

•

EKG: Pacer rhythm

Case 2 progression 0000

Patient Contact

0000

Vitals

???

Pt moved to unit via stairchair to stretcher

0012 0020

IV NSS Ux2, Blood glucose = 16 mg/dl IV NSS Sx1 20g, ? Fluids

0025

1 amp D50W IVP

0035

Transport to the Hospital

0040

Patient Arrests, pulseless V-Tach, Defibrillation

0065

Arrival @ ED, pt regains pulses