Emergency Airway and Breathing Cases

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The Macstrak Project ER Case Studies The following is a series of case studies to review different patient types and how they are captured on the form.

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Presentation transcript:

Emergency Airway and Breathing Cases Don Spaner MD EMS CCF East Region Medical Director

Cases to Sharpen Provider Skills 2 Y/O male with parents reporting their baby seems short of breath. You hear a barking loud cough. You see retractions with respiratory rate of 40 per min. The child feels hot to the touch. Is this airway, breathing or both? What part of the airway produces stridor? Treatment?

77 Y/O Female with SOB! V/S: 200/110 B/P, 110 P, 28 R, 86%POX, 28 CO2. Edema, JVD, HJR, Exertional dyspnea over last few weeks. Audible rales. Treatment? Be complete.

Heart Failure O2, IV, Monitor NTG Capoten CPAP Call for Lasix Don’t forget to call for Lasix.

40 Y/O Pt. Severe SOB After Eating Peanuts Sitting bolt upright with extreme SOB. B/P 140/90, p 110, r 30, Sat 88%. Treatment?

Be Aggressive: Time Is Everything Epinephrine 1:1000 IM .3-.5mg SC or IM(IM preferred) Benadryl 50mg IV Solumedrol 125mg IV Fluids if needed Transport(All significant reactions must be observed for at least a few hours)

62 Y/O Male Collapse Unresponsive. Unable to protect his airway but breathing. B/P 240/120, p52, r=14 snoring, pox 96% Mental status: not responding to verbal or noxious. Treatment?

Airway Airway Airway Don’t be fooled by the pule ox! Maximal pre-oxygenate before intubation!!!!! Proper position. Once intubated you must apply capnography.

Tracheal Cancer Patient Severe Stridor! Severe SOB! Will Not lay back! Dusky appearance. 180/100, p 130, r 30, pox 88% Treatment options? Hint: Options much bigger than what’s in the protocol!

80 Y/O Female With Fever. B/P= 70/50, P=130, r=30, hot to the touch. Appears very ill with CO2=24 Treatment options?

Septic Shock

35 Year Old Male Unresponsive at a Local Bar. No response to verbal or noxious stimuli. B/P=100/60, p=100, r=16, pox=96% Questions? Care? Clear liquid bottle next to patient.

Frat House Dare: 18 year old choking on a whole pizza! Suddenly choking. Not speaking. Is this airway or esophageal.

50 Y/O Stopped B/P Meds 3 Months Ago Suddenly Drops and is Unresponsive B/P 240/130, p=60, r=12, pox=93% Eyes fixed to the right. No gag reflex, airway compromised. Treatment? How will you manage the airway?

Middle Aged Male Drinking Water From a Local Farm Stream Suddenly He Collapses Starts to Salivate and is Incontinent.

4 Y/O Child Choked on a Peanut Butter Sandwich. Cyanotic Not Breathing! Pox=66% Treatment?