Call of the Quarter

On August 15^th the Glasgow Lifesaving and First Aid Crew was toned to respond for a patient who was unresponsive.  Medic 34 responded with EMT-P Watts and EMT-B Strowbridge.  Upon their arrival, they found a 35 year old male patient lying in a fetal position on the floor.  The patient was blue and unresponsive, with snoring respirations four times a minutes.  There was blood around his mouth and nose.  Bystanders advised they heard the patient fall against a wall, and slide to the floor where EMS personnel found him.  Bystanders were unable to provide the crew with any medical history or allergies.  There was nothing to indicate what may have been going on to create the scenario.  The crew rolled the patient onto his back where he became apneic.  The patients airway was full of frothy, bloody sputum.  After suctioning, intubation was attempted unsuccessfully four times.  The request was made to have Co. 2 respond to establish a landing zone, and EOC was requested to get Pegasus to respond.  Rescue 3 was also toned for additional man power.  The patient was moved to the ambulance where ventilations continued by BVM.  EMT-P Watts again attempted to secure an airway with a combitube, with 2 unsuccessful attempts.  The patient had begun to have spontaneous respirations, but only at 8 times a minutes.  He also had increased bloody material in his airway, and began to vomit a dark coffee ground substance.  EMT-I Hickman and EMT-E Grant arrived on scene.  The patient was then transported to the landing zone.  EMT-E Grant was able to establish a large bore IV prior to Pegasus landing.  The patient again stopped spontaneous respirations, at which point, EMT-P began to prepare for a surgical cricothyrotomy, but attempted a third attempt with the combitube.  This was a successful attempt, which resulted in the combitube in the trachea.  Capnography showed adequate ventilations.  After a successful airway was established, the patient’s pulse oximetry raised from 80% to 100%, and his heart rate dropped to a sinus rhythm and a rate of approximately 90 from a previous rate of 140.  By this time, the Pegasus crew was on the ground, and began their assessment of the patient.  Care was turned over to the crew.

During the assessment of the patient, there was nothing to indicate what may have caused him to collapse.  His abdomen was soft and non-tender, his pupils reacted normally, and his glucose level was 124.  His lung sounds were congested and diminished, due to the aspiration of blood.  One week later, the patient was back at work with no side effects other than some weakness and a sore throat.  Doctor’s diagnosed him as having a viral infection.