Israeli Paramedics Association
Only Trauma ?
By
Paramedic Neomi Zvi
11:30 pm , Saturday night . There were breaking signs all over the entrance door , and at least 30 family members around the unconscious 40 y/o mail pt (I called the Blue's )
In a small kitchen , we found the pt. supine , huge Hematoma all over the right side of his face , with deformation of the lower right frontal bone , orbit and the zygoma , the right eye was not in place , deep coma , 4-5 breath / min (Apneostic pattern) , Sinus Bradycardia of 28 / min central pulse only (no BP), very rigid muscles , very poor air entrance to both lungs , 1.5'' diameter of necrotic depression on the left lower chest with susp. ribs fracturs... And the pt. was hypothermic.
According the family - he is known as psychiatric and epileptic pt. - they don't know what meds he is on (I asked them to look for the meds) , and those I was talking to - could not tell what happened at the moment - only that they havn't seen him for 2.5 days and they found him laying on his face next to the wall.
Jaw thrust , OroPharyngial AW , BVM - were not enough , I took the risk and intubated the pt. and let the EMT ventilate him with 95% O2 (+ Stabilization of the head and neck) . Good and equal air entrance to both lungs now.
By chance the first attempt of IV was successful (I took blood for glucose level and for toxicity tests) . He was Hypoglycemic and Hypovolemic too.....
I needed second IV line - but no luck - so I gave up at the moment....and opened another IV line later on...(about 30 minutes to the nearest hospital)
Warmed the pt. , administered fluids and glucose.
In that point - pt was ventilated , HR of 55/min , BP of 110mmhg systolic , and after 25 G he was only 77mg% ....
Something in the back of my mind was bothering me....there was no "bad smell" ...How come the pt. did not urinate after 2.5 days.?!?....
I checked his belly.....His urine bladder was up to the stomach .
I insert Folley catheter and 1.4 Litter went out (I changed for a second urine bag).
His heart rate jumped almost immediately to 115 / min.I checked again the air entrance again - it was okay. (the family brought his meds..Lithiume ..)
Put him on back board and started to move downstairs.
In the MICU - I reavluate the pt. , he was much less Hypothermic , BP of 120mmhg , Sinus Tachy of 110/min , pupils are equal , nerrow and responding to light , GCS of 6 , with spontaneous breathing of 8/min BUT - pneumothorax on the left !...okay....Niddle Application on the way to the hospital.
I reported the hospital and asked them to prepare the resuscitation room and that I'll be grateful if they can call for Toxicologist & Traumatologist (they don't have any).
In the Hospital:
A short while after midnight...we entered the ER.
One young doc on duty looking at us and say:
OHHH - car accident.....I asked the doc: who will put the thorax drain ? you or me ?
he said: you ! I said: Okay...sign here...and I put the thorax drain in place .
I toled the doc that I think it is Lithium toxicity..(causing bradypnea , bradycardia and hold pt from urinat)....and the trauma is due to seizures...
All X-rays confirmed diagnosis and tubes place / position
Outcome:
The pt. was back home after 10 days
----------------
The pt. , living on his own , were suppose to go out of town to his brother's house on Thursday morning for the weekend and was expected to come back on Saturday night.
His syster called his house on Saturday night - but no answer. she called her brother out of town - and he said: he did not come at all. The pt. was missing for 2.5 days
So the family break into the pt.'s house and found him with his head against the wall (that caused the facial trauma) and leaning on the broom stick (causing the ribs fractures , the necrotic wound and the pneumothorax (that developed after he was warmed up)......
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Paramedic Neomi Zvi - Jan 2000