You are working as a Paramedic on an EA with a Technician colleague and have been called to a 23-year-old female who has been vomiting and has collapsed. You arrive on scene and are welcomed into the property by the patients’ parents. They explain their daughter was out last night with friends, she doesn’t drink much normally. She got home at 11 pm and didn’t seem drunk at all. Today she has been vomiting and looks unwell. They called the ambulance as she collapsed and they have been unable to wake her.
0 of 10 Questions completed
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading…
You must sign in or sign up to start the quiz.
You must first complete the following:
0 of 10 Questions answered correctly
Time has elapsed
You have reached 0 of 0 point(s), (0)
Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)
Well done on completing the quiz. You need to score 70% or more in order to get a certificate. When you pass your quiz remember to download your certificate as proof of completing this quiz. Try and score as high as possible to show your knowledge on this subject.
You enter the room where the patient is lying in a recovery position. You see she is unconscious, very pale, and rapidly breathing. You try to get a response from her but there is nothing. There is vomit pooling from her mouth with gurgling noises, her respiratory rate is around 40, and she has a weak radial pulse around 135 bpm.
What management should you look at first
There is a lot of vomit in the airway with gurgling at the back of the throat. You attempt postural drainage and suction the airway with some success, but there is still some compromise. What further action in the stepwise airway approach can you do next
You place an OPA and the patient’s airway is now under control. Your colleague has started to conduct observations while you continue with your assessment. You assess breathing and note a rapid respiratory rate, around 40, with bilateral air entry. You auscultate crackles on all lobes and query the patient has aspirated some vomit. SP02 levels are reading 89% on air, what further action should you do
You apply O2 and the SP02 climbs to 96%, and the patient’s colour is less pale now. As you move onto circulation, your colleague reads out observations: Respiratory rate 38, Heart rate 132, BP 79/43, CRT 4 seconds, temperature 37.9°c, blood sugar 3.7 mmol.
Working through circulation, you note no obvious causes for haemorrhage. You start to cannulate the patient. What action would you complete next
You start administering Sodium Chloride and site a second cannula to start some Glucose 10%. Given the observations, what is the patient’s NEWS Score: Respiratory rate 38, Heart rate 132, 96% SP02 on O2, BP 79/43, CRT 4 seconds, temperature 37.9°c, blood sugar 3.7 mmol, U on AVPU
You have a number of differentials for what may be happening. Your colleague completes a 12 lead ECG but the rhythm is sinus tachycardia, no other obvious abnormalities. You have your medications running but the patient remains in the same state. Your colleague goes to get extrication equipment while you manage the patient. The parents are standing in the doorway watching your efforts. You ask if there is any more info they can give about the patient, medical history, medications, allergies…
They explain she has no allergies, but had Pituitary gland surgery when she was very young and has to have regular hormone replacement therapy. This past week she has been under the weather and missed several doses, but this has never been a problem in the past.
Given this new information, what may be the cause for the patient’s unwell state
Given the information of Pituitary Gland surgery requiring hormone replacement therapy, what type of Adrenal Insufficiency is this
What management is required for Adrenal Crisis
What dosage of Hydrocortisone IM is recommended
You administer the Hydrocortisone as your colleague returns with the scoop and stretcher. You safely extricate the patient from the house into the Ambulance. In the back you conduct further primary survey and observations. The patient’s condition has seemed to stabilise. Is a pre-alert still necessary for the patient and condition