Collapse DIB Scenario

What should be your first priority?

There is no angioedema or blockage evident in the airway so you move on. You ask your crew mate to get some oxygen ready whilst you listen to the chest. All chest sounds are clear and the patient is breathing effectively by themselves, so you are unsure what is causing this cyanosis. What mask would you like to start with before you get your initial observations?

You place on your none-rebreather mask and complete your initial observations. You record 115 HR, 28 RR, 78/65 BP, 84% Sp02, 36.1 Temp, 5.2 BM and GCS 8 (E1, V2, M5). What is this patients NEWS score?

Your patient has been on 15L/min for almost 5 minutes now and the Sp02 is still only 85%. You try and get any more information from the friends and the scene. The friends state they were out the night previously for drinks and he was acting normally. They are unaware if he has been unwell recently and they haven’t got the patients next of kin details. You go back to the patient as he has started to vomit a lot and is filling the airway. He is still breathing but is unable to protect his airway. What would be your most appropriate, initial action to help the patient? 

You lay the patient on their side to let the vomit drain. A second crew arrive, you ask if one of them can sort extrication and the other to see if they can find anything that may suggest how this patient got in this condition. Your patient seems to be deteriorating with obs now of 122 HR, 30 RR, 70/54 BP, 85% Sp02 on 15L/min. You cannot see any external injuries or bleeding on a brief examination. You gain IV access. What medication could you start?

You start a fluid challenge to try to correct the blood pressure. You are considering other options when your colleague shouts out there is a pot of white powder on their desk with a teaspoon inside. The glass is almost empty and there are remnants of this powder evident in the glass. The substance is Sodium Nitrite. There is also a packet of anti-emetics on the desk. What could this be evidence of?

You suspect a suicide kit has been used. You are unsure about sodium nitrite, what tool could you use to get reliable specific medical information?

You quickly search on Toxbase and see the substance is very toxic. This incident has potentially turned into a HazMat incident and therefore should you contact HART for advice or should you continue on as normal?

You contact HART and they have been notified by control already, they are almost at scene. They advise you not to touch the substance and they will be with you shortly. What methods of absorption could cause overdose with sodium nitrite?

What kind of toxin is sodium nitrite?

The HART team have arrived and are wearing enhanced PPE. They ask for a handover and proceed to take care of the patient whilst you leave scene. Shortly after, you hear the patient has gone into cardiac arrest. Are you able to ROLE a patient after ALS in this scenario?

Do hospitals carry specific antidote for an asphyxiant toxin such as sodium nitrite?

What pathophysiology lies behind the ingestion of sodium nitrite and is related to the development of a cyanotic complexion and false readings of Sp02 at around the 85% mark regardless of oxygen therapy?

What other recreational drugs have been reported to cause methaemoglobinaemia?

What early signs and symptoms may you witness in patients with methaemoglobin?

Sodium Nitrite suicides are on the rise as the product is easily accessible to buy online and is easy to administer?