Oral station scenario

BACKGROUND INFORMATION
EMS System description (including
Suburban EMS that responds to both emergency and non-emergency calls urban/rural setting) Vehicle Type/response capabilities 2 person paramedic level transporting service Proximity to and level/type of facilities 30 minutes to the attending physician’s office 15 minutes to community hospital DISPATCH INFORMATION
Nature of the call
Woman can’t walk, requests transport to physician’s office, non-emergent Well kept walk-up single family dwelling Daughter who is serving as primary care giver SCENE SURVEY INFORMATION
Scene considerations
10 cement steps up to the front door No access for stretcher from any other doorway 1st floor, back bedroom, narrow hallways & doorways Patient sitting in bed with multiple pillows holding her in an upright position, pale in color, does not respond to your presence in the room PATIENT ASSESSMENT
Chief Complaint
Daughter states “My Mother just passed out a couple of minutes ago from the pain.” Patient woke this morning with a painful left leg that has increased in pain, unable to walk without severe pain. Daughter states that her mother, “Has a small sore on her left inner thigh that has gotten bigger over the past few hours and her doctor wants to see her in his office.” Patient opens her eyes to loud verbal stimulus but does not verbally respond pertinent negatives
PAST MEDICAL HISTORY
Past Medical History
Adult onset diabetic controlled with diet and oral medication, hypertension, hernia repair years ago Glucophage bid, Lasix 20 mg qid, diltiazem qid, and Colace qid NKA Patient lives alone after death of husband two years ago, daughter comes to her home each day to help her mother with daily chores
EXAMINATION FINDINGS
Initial Vital Signs
BP 100/palpation P 130, rapid and weak R 8 Opens her eyes to loud verbal stimulus and withdraws to pain Utters incomprehensible sounds Pupils equal and responds sluggishly to light Large ecchymotic area over the patient’s entire left inner thigh extending into the groin, pelvis, and left lower abdomen Area is hot to touch with crepitation under the skin Skin is pale, hot, and moist to touch PATIENT MANAGEMENT
Initial stabilization
Assisted ventilation with high flow oxygen Assisted ventilation with high flow oxygen IV enroute Consider transportation to facility with immediate surgical capabilities and hyperbarics TRANSPORT DECISION
Lifting and moving patient
Place in Reeves stretcher to ambulance stretcher CONCLUSION
Field Impression
Rapidly extending extremity infection, febrile, hypotension, and tachycardia, with altered LOC What is the basis for the septic shock in this case? Severe bacterial infection MANDATORY ACTIONS
Rapid identification of life-threat and immediate transportation to the emergency department
High flow oxygen
POTENTIALLY HARMFUL/DANGEROUS ACTIONS ORDERED/PERFORMED
Delayed transportation for on scene interventions
Taking the patietnt to the doctors office.
BACKGROUND & DISPATCH INFORMATION FOR CANDIDATE
You are a paramedic on a transporting paramedic unit. You are working with a paramedic partner in a suburban EMS system. You are thirty (30) minutes away from the attending physician’s office and fifteen (15) minutes from the community hospital. At 1512 hours, you are dispatched to a residence for a non-emergent transport of a woman to her doctor’s office. It is a clear spring day with a temperature of 68°F. A woman who identifies herself as the patient’s daughter meets you at the door.

Source: http://www.nremt.org/nremt/downloads/Oral%20Station%20Scenario.pdf