Transcript Teaching Case 1 Mr. Kruski

Teaching Case #1
Mr. Kruski
45 Y/O
180 lbs.
MALE
Dispatch
8550: “Dispatch, 8550 is on the air”
Disp: “8550, a fall, code 3 at the
Minneapolis/St. Paul airport
Building B. Northwest Airlines.”
8550: “Received, responding Building B”
Disp: “Incident 48754, time out 1030 hours,45
year old male, Conscious and Alert. Patient
is pinned under construction equipment.”
8550: “Received, thank you”
Scene
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Pt. Interventions
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Scene/MOI
You arrive on scene to find:
a man laying supine. His coworkers
state he was struck by a falling
barrel that weighs approximately
800lbs. The barrel fell from a height
of approx. 10 feet. They removed
the barrel before you arrived.
Scene
Interview
Pt. Interventions
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Interview
Introduce yourself
What question would you like to ask?
• Do you have any allergies to
medications?
• Do you take medications?
• What is your past medical history?
• When did you eat your last meal?
• What events led to you to call us?
• More HPI questions (OPQRST)?
Scene
Interview
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Courtesy
goes a long
way,
doesn’t it?
Introduction
EMS: Hello, my name is Jane EMT and I will be
taking care of you today Mr. Kruski. What
happened?
PATIENT: Thank you for introducing yourself… aah
my hips hurt.
EMS: Mr. Kruski, did you loose consciousness?
PATIENT: No and please call me Bernie…
<Pt. Is not able to move>
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HPI
What question would you like to ask?
•
•
•
•
When did your symptoms start?
What were you doing when this began?
Is it a sharp or dull pain?
Does it radiate or go anywhere?
• What have you done to make yourself feel
better?
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OPQRST:
Onset
Injuries occurred after a barrel
fell on top of the patient. The
patient denies Loss of
Consciousness.
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OPQRST:
Provocation
“Like my co-worker said: A
barrel fell on top of me, you
don’t listen very good do
you?”
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OPQRST:
Quality
Constant and sharp.
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OPQRST:
Radiation
• Mr. Kruski: “No it is just in my
hips. Please help me.”
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1
5
10
OPQRST:
Severity
• 10 over 10. Mr. Kruski
answers questions very
slowly and in a low tone of
voice. He is starting to feel
groggy.
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OPQRST:
Time
• Injury occurred only a minute
or two before EMS was
called.
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Allergies
• Mr. Kruski: “I get terrible
hayfever, I think it’s the pollen
and ragweed”
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Medications
• I don’t take drugs of any kind. My
doctor Katheryn Richards doesn’t
believe in that stuff.
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PMH
• None
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Last Meal
• Pt. Can’t remember.
• His coworkers say he always
has breakfast with them but
he didn’t show up this
morning because he has an
errand to run at Target.
Scene
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Events Leading to
Present Illness
• Pt.’s coworker:
“ We were moving some barrels
on the shelves. We should have
been using a forklift but we were
in too much of a hurry.
Do you think he’s going to be
OK?
I’m very sorry… REALLY sorry.”
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Physical Exam
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PE: HEENT
•
•
•
•
•
•
Scene
No sternal notch retractions
trachea midline
Clear of fluids
No JVD
PERL
Skin is pale, clammy, cool
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PE: CHEST
• No tenderness or abnormality
on palpation
• Chest Rise is equal
• No use of accessory muscles
• Clear, Equal Bilat. Lung
Sounds
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PE: EKG
Monitor shows:
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PE: Neck/Back
• No deformities, discoloration,
tenderness.
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PE: Abd./Pelvis
•
•
•
•
•
•
Scene
Soft
No masses
Non-Tender
Pelvis is unstable.
No crepitus.
Extreme pain on palpation.
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PE: Extremities
• No sensation or movement
bilaterally below the level of the
waist. Pedal pulses are thready
but present.
• Capillary refill is delayed in finger.
• Handgrips strong and equal.
• No Pedal Edema
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PE: Vital Signs
Current Vitals are:
Scene
Time
BP
1038
108/70
1045
100/p
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P
R Qual Sa02 LOC
128 24
IRR
120 24
NL
98%
A
NL
98%
V
PE: Diagnostics
• Glucometer: Not Obtained
• End Tidal CO2: Not
performed
Scene
Diagnostics
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Pt. Interventions
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Pt. Interventions
• Mr. Kruski’s coworkers have
been holding his head and
trying to keep him still.
• The 800 pound barrel has
been removed.
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