"Clinical Paramedic Procedures" is a wonderful example of a paper on symptoms. You are a paramedic crew who despatched cat 2 to a collapse. Your patient is a 65yo female sitting in a recliner chair complaining of palpitations. Her son has called the ambulance as she kept passing out when she was sitting talking to him. She says that she has had a fast heart rhythm in the past but does not know what it is called. She weighs 126kgs. On Examination: GCS: 15; CVS: skin pale cool and moist, no radial pulse, weak brachial pulse, HR 180, BP 70/40.
Pt is complaining of feeling dizzy ++ and palpitations. No chest pain. The stretcher is unable to be brought into the house. There is an ICP crew responding, they are five minutes away. How are you going to manage this patient as the first crew responding? In this patient, a history of palpitations, similar complaints in the past, and symptoms of cardiogenic shock, point towards a diagnosis of an unstable tachycardia, most likely atrial fibrillation. As the first crew responding, I will ensure that the airway is clear and breathing is maintained and I will administer oxygen through a mask.
As the perfusion is compromised, I will insert an IV cannula and start an infusion line. Meanwhile, I will make sure that a defibrillator is available or on its way because the patient is likely to need cardioversion. Also, I will ask questions to elicit the cause that precipitated the arrhythmia and will prepare the rate-controlling drugs. When the ICP crew arrives they ask you to plan how you will move this patient out of the house.
Describe how the patient is to be taken out of the house and placed on the stretcher. As the patient is hypotensive, she needs to be placed in the supine position. She can be manually lifted out of the reclining chair by the members of the crew and shifted out of the house in a patient carry sheet(at least 4 are required) from which she is shifted to the stretcher and the ambulance. Also, as the patient is responding and is already in a reclining chair, the patient can be shifted onto a carry chair by manual lifting done by two of the crew members.
The patient’ s arms are kept close to the body and bent at the elbows. One member stands behind the patient and hooks his arms under the patient’ s shoulders and clasps across her chest. The other member then helps lift the patient onto the other transfer device. Case 2 An 18yo male is unconscious (GCS 3) on the bed from a suspected ‘ Fantasy’ overdose. There are no ICP crews available. His airway is clear, his breathing is a normal effort at a rate of 24, and he has a strong radial pulse at a rate of 120.
The bedroom is at the back of a house with narrow corridors. The nearest you can get the stretcher is in the front yard. The house has three stairs going up to the front veranda. The patient weighs 80kgs. A young male is found unconscious due to a suspected drug overdose. The patient’ s airway is clear and he is hemodynamically stable. All crew members follow universal precautions while manually handling the patient in view of the drug abuse scenario.
The patient is manually lifted onto a transfer board using a pat slide or a draw sheet. The crew members carry the transfer board across the narrow corridors and three stairs to the stretcher. The patient is shifted to the stretcher, put in a recovery position, and transferred to the nearest medical facility. Case 3 A 65yo male is presenting with an acute exacerbation of his chronic back pain. The pain is so severe that he is unable to walk. He is upstairs on the bed in his bedroom.
At the base of the stairs, he has highly polished floorboards leading to the front door. His house is at Waterfall Gully, he has a very steep concrete driveway that slopes down towards the road. You are unable to get the ambulance or the stretcher up the driveway. He weighs 150kgs. This case presents the following problems: 1) Morbidly obese patient which makes the load difficult to handle. 2) Patient is having acute pain, so not likely to cooperate or contribute to the handling operation. 3) Patient is upstairs, so the operation is to be performed in a restricted and unsafe space. 4) Ambulance or stretcher can’ t be taken up the steep driveway. Planning is important before actually transferring the patient.
The patient is in bed due to back pain and should be shifted in supine posture and rolled like a log without rotation or movement of the spine to minimize pain. Logrolling of the patient involves communication and coordination by all the team members. The patient is transferred from his own bed to an inflated HoverJack mattress, raised to the level of the patient’ s bed, using a pat slide or a spine board which is first inserted under the patient.
HoverJack is then used to slide an obese patient down the stairs and across the floorboards leading to the front door and down the driveway to the ambulance.
Gregory, Pete & Mursell, Ian 2010, Manual of Clinical Paramedic Procedures,