You are working as part of a Paramedic, Technician crew when you are allocated a job for an 81-year-old male who is having a seizure, ineffective breathing. You start responding to the call on blue lights. You arrive at the property to see a frantic member of the public in the doorway. They explain to you it’s his father who seemed to have a funny turn, fell to the floor, and started having a seizure. The seizure lasted around 6 minutes before stopping. The patient has since been in an unresponsive state.
You make your way to the living room to find the patient supine on the floor. They are a pale/ashen colour, have a high respiratory rate around 45 breaths per minute, and have obviously been sick with vomit around their airway and some very noisy upper respiratory sounds/snoring. They are GCS 5 (2/1/2), and there are no obvious signs of bleeding or injury.
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What is your first primary survey management/intervention in this scenario
You turn the patient on their side with a head tilt to use some postural drainage. The airway sounds a bit clearer in this lateral position but there is still some noise and airway obstruction. You suction which helps a little more, but there is still an airway issue. What stepwise airway approach can you utilise next
You attempt to place an Oropharyngeal Airway, but the patient starts gagging and choking on it. The patient isn’t tolerating it well, and you decide it best to remove. What further stepwise airway approach can you utilise
You place the Nasopharyngeal Airway in situ and this helps. Using patient positioning and keeping him on his side helps maintain airway patency. You conduct a FLAPS breathing assessment and note consolidation on all lobes from aspiration. The patients’ Oxygen saturations come back as 84%. What is your next action
You place 100% O2 on the patient and move onto circulation. You note the patient has very pale and clammy skin. You feel for a radial pulse but cannot locate one. The patient still has a carotid pulse. You do a blood pressure and it comes back at 78/43. You cannulate the patient, what medication can you give to help raise the blood pressure for the current situation
Fluids are being administered and you try and lift the legs where possible as well. A quick view on the 3-lead shows a tachycardic irregular narrow rhythm at a rate of 130 bpm. Following your circulation review, what assessment will you move onto next
You start assessing disability factors. There’s no obvious head injury present, they are still in a GCS 5 (2/1/2) state with abnormal extension. You do a blood sugar test and it comes back as 6.9, and temperature is 36.8. You assess pupils to see their response. What mnemonic assessment can you use for pupil assessment
On assessing pupils, you note they are sluggish in response and the left pupil is much smaller than the right. Given the information from the incident of abnormal flexion, unequal pupil size, seizure activity, and low GCS, what is your impression of the pathophysiological event going on
You review that there is a neurological event ongoing, potentially a cerebrovascular haemorrhage causing the pathology and symptoms. You quickly review the patient for any further injury or pathology but cannot find any issues. What is your next step in your treatment plan
You plan with your colleague the extrication method. You note that the fluids still haven’t brought up the patients’ blood pressure, and the only way you can maintain the airway is by keeping him on his side. There is a straight path into and out of the property and is close to the Ambulance. Your colleague suggests getting a carry chair, given the circumstances which method do you feel will be best for the patient