Question

ambulance calls
the following case scenarios provide an opportunity to explore the concerns associated with patient management and to enhance critical - thinking skills. read each scenario and answer each question to the best of your ability.

1. you are dispatched to \difficulty breathing\ at one of your towns many parks. as you near the park entrance, you see a crowd of people who frantically wave for you. you arrive to find a city employee who was apparently mowing the park grounds when he accidentally mowed over a yellow jacket nest. he was wearing coveralls, but he was repeatedly stung around his neck and face. he appears to be somewhat confused; you can hear stridor with each inspiration, and his blood pressure is 80/40 mm hg. your local protocols allow emts to carry epipens.

how do you best manage this patient?

1. you are dispatched to an \unknown medical problem\ at the crosstown mall. you were called after police were summoned to subdue a combative male shopper. police officers were able to calm him down but felt that something was

ot right\ about him. you arrive to find a calm but confused man who is sweaty and pale. he has no complaints but keeps repeating, \i have to get home now.\ you notice a medical id bracelet indicating that this patient is an insulin - dependent diabetic.
how do you best manage this patient?

1. you are dispatched to the residence of a 68 - year - old man who is complaining of \crushing\ chest pain radiating down his left arm and trouble breathing for the past hour. he is pale, cool, diaphoretic, and is very nauseated. he tells you he had a heart attack several years ago and takes nitroglycerin as needed. he took two tablets prior to your arrival and reports no relief.

how would you best manage this patient?

Explanation:

1. The patient has been stung by yellow - jackets, has stridor (indicating airway compromise) and low blood pressure (shock). The best management is to first administer an EpiPen to reverse the anaphylactic reaction, then provide high - flow oxygen to support breathing, and rapidly transport to the hospital for further treatment.
2. The patient is an insulin - dependent diabetic, confused, sweaty and pale. This may indicate hypoglycemia. Check the blood glucose level. If low, give oral glucose if the patient can swallow, or if unable to swallow, start an IV and administer dextrose in the hospital setting while transporting.
3. The patient has symptoms of a possible heart attack (chest pain, nausea, etc.) and previous history of heart attack. Administer oxygen, attach a cardiac monitor, give aspirin (if not allergic), and rapidly transport to the hospital for further evaluation and treatment such as possible thrombolytics or PCI.

Answer:

1. Administer EpiPen, provide high - flow oxygen, rapidly transport.
2. Check blood glucose, give oral glucose if able to swallow or IV dextrose if not while transporting.
3. Administer oxygen, attach cardiac monitor, give aspirin (if not allergic), rapidly transport.