By Patrick Lickiss
You are on the ambulance and staged at a working residential structure fire. After your arrival, you were advised that the fire appears to have started in the basement and spread up the stairs into the kitchen.
You hear the following radio traffic.
“Medic 44 from Engine 2, we will be coming out to your location with a male occupant. He isn’t responding and has shallow breathing.”
The patient brought to you is identified as a 16-year-old resident of the home who was sleeping in an upstairs bedroom when the fire started.
As the firefighters lay him onto your stretcher, you notice that the patient is unresponsive with his eyes closed. He appears to be breathing but his rate is rapid and his breaths shallow.
You are unable to find a radial pulse but do note a bounding carotid pulse. A primary trauma assessment reveals no obvious burns or injuries. The patient’s vital signs are:
- BP: 76 systolic
- HR: 110
- RR: 32
- SpO2: 100%
Another ambulance is already on scene to handle firefighter rehab so you can initiate transport at any time.
Think about these questions as you consider what to do next.
- What other assessments would you perform?
- Do you have any concerns about your vital sign findings?
- What is your working diagnosis?
- What treatment options are you considering?
- If untreated, how do you expect your patient’s presentation to change?
Post your answers below in the comments and view the clinical solution for this patient.
About the author
An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.