You are working with a Technician on an EA, it is the afternoon of a busy day shift, and you receive a call to a dizzy/unwell male. You promptly arrive on scene where the door is ajar. You grab your kit and enter the property. As you enter, you call out and a reply comes from the front living room. Sat on the sofa is a male patient in his sixties. He explains that he has been feeling unwell in the house over the past couple of weeks with dizziness, lethargy, and nausea. Today he felt he couldn’t walk properly and felt unwell. He was wondering if he may have had a stroke as he just can’t concentrate on things properly.
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What assessment will you use for the initial assessment of the patient
You start conducting your primary survey, there’s no trauma or Catastrophic Haemorrhage, his Airway is clear, 98% O2 saturations, listening to breathing there is bilateral air entry, no issues on the FLAPS assessment. On Circulation, you note he has a weak radial pulse with Heart rate around 60 BPM. Your colleague starts a Blood Pressure. With that you hear what sounds like a fire alarm coming from one of the rooms further in the house. You question the patient as to what the noise is and he replies “Don’t worry about that, it’s a Carbon Monoxide alarm I’ve got in the Kitchen next to the boiler. It’s been playing up over the past few weeks, going off and on all the time. I’ve changed the battery, but it still keeps going off.”
What are your following actions
Given the new information, what potentially dangerous condition could the patient have
You realise the potential danger and remove yourselves and the patient from the property. On the ambulance you explain to the patient that you believe he may have be suffering from Carbon Monoxide poisoning and hasn’t realised that his alarm was actually notifying him of the danger. What question may be important to ask as per the current situation
The patient says he lives on his own and no one else lives in the property. You notify control of the situation and they notify the Fire Service who have a 10-minute ETA.
On the stretcher the patient is starting to feel unwell and dizzier, given a change in the patients’ condition, what should you do
You start reviewing the Primary Survey again and work through the different systems. There’s again no obvious Catastrophic Haemorrhage, Airway is patent, clear, with 98% O2 Saturations, Breathing is still normal on assessment with no deficits. Is there any further treatment you should aim to complete before moving on to assessing circulation
Given the context of the situation and new information, what treatment should you apply to the patient
What does Carbon Monoxide and Haemoglobin form
As you apply the O2 mask, the patient goes very pale and his respirations drop to a rate of 4 per minute, the Airway is still clear and patent. What actions do you need to take
Your colleague passes you the BVM and you begin to assist the patient with ventilations. The ventilations are effective with good mask seal and rise and fall of the chest. Around what rate are you aiming to assist the patients’ ventilations
Your colleague notifies control for further back up and they respond that there’s a Paramedic on an RRV 5 minutes away. You continue to maintain the Airway and Breathing as your colleague gets observations; O2 Saturations 97%, HR 65, BP 97/44, Blood Sugar 6.7, Temperature 36.8⁰C, GCS 9 (2/3/4), ECG looks NSR. Within the context of the scenario, are O2 Saturations reliable with Carbon Monoxide Poisoning
The RRV Paramedic arrives along with the Fire Service who enter the house with breathing apparatus. You give the Paramedic a brief of the events and he starts to cannulate the patient and assist with his management. Your colleague starts transporting you to A&E while the Paramedic puts in a pre-alert. You continuously re-assess your Airway and Breathing management, and you are happy that it is well controlled with patient ventilations being supported. Other than 100% O2 and Hyperbaric Oxygen Therapy, is there any other current antidote/specific treatment for Carbon Monoxide Poisoning