ICE Scenario

Arriving on scene, you locate the car and can see there are fumes in the cab. The 999 caller has been up to the car to try and pull the patient out but were overcome by the fumes and had to step away. The caller described that he could see what looked like several disposable BBQ trays in the car with the patient. Your ECA starts making their way to the car to get the patient out. What actions should you take

You call to your colleague and advise them to standoff. You explain the fumes could well overcome them in their rescue attempt, and then 2 people would need saving. As you explain, the Fire Engine comes around the corner and the staff immediately jump out and don breathing apparatus. The Watch Manager come over to you and explains they will quickly extricate the patient to your position. 

You get the stretcher ready and the Fire Staff quickly drag the patient into your care. You quickly see that the patient has reduced GCS, poor breathing effort, and noticeably cherry red skin. Given the history of events and circumstances, what poisoning has the patient suffered 

You get the patient quickly into the Ambulance and start to manage the them. Your colleague asks whether Carbon monoxide poisoning is contagious and should you be wearing additional PPE 

You explain the pathophysiology of Carbon Monoxide poisoning and that it is unlikely to affect them being with the patient. For good measure and your colleague’s confidence, you leave the vehicle windows open while you stabilise the patient. Running through your primary survey, you note airway is patent, breathing is poor at a rate of 4 breaths per minute but clear auscultation, the patient has a weak radial pulse of 51 beats per minute, and is GCS 8 (2/3/3). What management do you need to action first 

You ventilate the patient with a BVM and get your colleague to attach Oxygen. They advise you that O2 saturations are reading 99%. Within this scenario, are O2 saturations a reliable indicator 

You discuss how Carbon Monoxide poisoning can give false O2 readings and continue to ventilate. The ECA comes back with further observations; ventilated at 10 per minute, heart rate of 64 per minute, blood pressure 82/43, temperature 38.4°C, blood glucose 7.3. Given the readings, what further treatment could you look to give the patient

You note the reduced BP and higher temperature, and advise the ECA to take over the ventilation effort. You cannulate the patient and set up a bag of sodium chloride. What initial dosage will you look to administer for this patient 

The sodium chloride is set up and you allow passive cooling to continue with the patient. You reassess your primary survey and quickly assess for any other clinical findings. On assessing the arms, you note recent IV drug use. What can you look to give to help combat any potential IV drug abuse 

What is the initial IV dosage of Naloxone Hydrochloride in this scenario

Another Paramedic has arrived on an RRV and jumps in the back with you. You quickly hand over the situation and take over the ventilation from the ECA. You start travelling to hospital, continuing to support ventilation. The patients’ GCS has come up following the Naloxone, but they still require ventilation support. Which of the following information will you give the hospital