EtOH Toxicity September 15, 2014
Primary Assessment • Form a general impression. • Do they need C-Spine? • AVPU • A&O assessment • What’s your name (from ID)? • Who is the president of the United States? • What state (location) are you in right now? • What is the year? • Determine any life threats. • Do not be tricked! Conscious and breathing patient does not necessarily mean a stablepatient
Primary Assessment • Airway and breathing • Are they talking to you? If so they have open airway – but be prepared for suction • Do not hesitate to give oxygen! • Circulation • Assess the patient’s circulatory status and pulse and skin condition • Cap refill!
Primary Assessment • Transport decision • Based on: • Vitals (Are they stable?) • LOC • Trauma (Any obvious deformities i.e. evisceration at a tailgate two years ago) • Recommendation from fire safety
History Taking • Investigate the chief complaint. • If your patient is responsive, at this point begin to take a SAMPLE history. • If your patient is not responsive, obtain this history from bystanders (i.e. friends, family, ID, medical bracelets!) • If unresponsive use ALS, and gather as much information as possible for them (with at least one set of vitals)
History Taking • SAMPLE history • Use SAMPLE as a tool of deductive reasoning to determine underlying conditions • Also, ask the following questions: • What is the substance involved (may not just be alcohol)? • How long ago did the patient use this substance? • How much of the substance did the patient consume? • Consider how much patient weighs when taking into consideration substance abuse • A 200 lb frat bro who is only responsive to pain only after 2 beers has something else going on with him
Secondary Assessment • Physical examinations • Look for DCAPBTLS • Vital signs • Look for alterations in the LOC, HR, R, BP, and skin signs.
Reassessment • Reassess ABCs. • Repeat the assessment of vital signs: • Every 15 minutes for a stable patient • Every 5 minutes for unstable patient • Average LAFD response time is 6 minutes. You should have at least one set of vitals and a SAMPLE done by the time they get there (unless unresponsive)!
Possible Underlying Conditions • Trauma • Shock • Electrolyte disturbances • Cardiac disorders • Alcoholic Ketoacidosis
General Tips • Control the scene • Be confident (use the cheat sheet!) and don’t let the patient/patient’s friends bully you • You are here because they need help, and as a result you need to get certain information/vitals from them • Be friendly, yet stern