My first call as a lone medic. BLS FD responded as well.

Dispatch Notes:

25 y/o Male unresponsive. Breathing. Law enforcement on scene.

Upon Arrival:

25 y/o male found sitting in recliner unresponsive with decreased respirations about 10/min. LE was on scene to arrest the indiviual for previous crime (grand theft). The patient was as is when they arrived. Unknown when the last time he was seen in a normal state. The patient was cool, pale, and diophoretic with dried emesis on his chest and around his mouth. An empty prescription bottle of Tramadol was found in a nearby bedroom.

The patient failed to respond to verbal or painful stimuli. His initial blood pressure was 110/70 with a heart rate of 130. He was considered to be in compensatory shock. Opiate overdose was assumed due to his symptoms. No peripheral venous access was made after 2 failed attempts, and an external jugular vein was accessed. Narcan was chosen for administration to avoid having to intubate the patient (no back up medic on scene, hoping to just wake this dude up). Narcan was administered Slow IVP with a running line. The patient's respirations increased slightly and his O2 saturation improved (unsure of the actual percent). The patient began to display with abdominal contractions and the IVP was stopped. The patient presented with what appeared to be tremors, and was loaded up for transport. He did not regain consciousness, but frequently yawned in between "tremor episodes".

In the Ambulance: just me back there

Just as we left the residence the patient's oxygen saturation began to drop with little increase in respiratory effort. His respirations decreased to about 8/min. BVM was applied to control the rate and depth with possitive increase in oxygentation. At this moment the patient began to decompensate and displayed with severe hypotension. A Dopamine infusion was set up in between ventilations and started. The patient continued to present with "tremors" and yawning.

Arrival at the ED:

ER RN states "Is he seizing?"
ER Doc orders 10mg of Ativan

This call opened my eyes. I don't know it all! The whole time the patient was displaying with tonic/clonic activity that the genius in me said was tremors. I researched Tramadol, learning that it has opiate properties but is considered a non-opiod analgesic. If Narcan is administered to this patient, seizures are a common side-effect. I learned that you can yawn while having a status episode. If I would have utilized our RSI protocol, the seizures wouldn't have been a problem, the airway would have been controlled, and I would have had a much easier time. Not to mention the obvious possibility of aspiration. Keep this in mind the next time you are treating a tramadol(Ultram) OD, learn from my huge mistake. They initially got the kids pressure up, and he suffered no perminant brain damage.

Tramadol & Narcan Interactions
Yawning with seizures

About Me

My name is Adam Thompson and I am originally from Fort Lauderdale Florida. I went to fire school straight out of high school and only went to EMT and paramedic school because I had to. Getting a job on a fire dept. in Lauderdale is nearly impossible without your medic ticket. To my surprise I liked the medical aspect as I became an EMT. I even decided to pick the "tough" paramedic instructor at my college.

So as I began my first semester of medic school I began kicking myself for picking the tough guy. My class started with 75 students in a day & a night class combined. We quickly dwindled down to 60 after the first semester, 45 after the second, and 30 after the third. 9 of us graduated from the class. Not everyone failed, some got hired, transferred out, or just quit. I made it though, and my medic instructor managed to instill in me a little of the passion he had for the job.

As it became time to find a department to work for I found my self wanting. I wanted an outside-the-box department with progressive protocols. Ft. Lauderdale just didn't have that, the FDs in Broward County had a few good medics, but they were confined to a witless protocol book(Not witless medics, but a list of protocols that didn't allow much). This wasn't exactly what I had learned to appreciate. I would have taken a job though, but a couple counties West I found a gem; Lee County EMS. Wasn't a fire department so I was a little disheartened, but I decided to apply anyhow. The protocols were just too good, and looked like a pretty big organization. Needless to say, I was hired shortly after.

I am have been with LCEMS for 3 years now and I am a credentialed lead paramedic. I am also on our ALS competition team, and our QI/QA committee. I am a rescue specialist on the local Urban Search & Rescue team, Task Force 6. I am also an EMS educator for Edison State College, and I am currently pursuing the

I guess the purpose of this blog will be to just log some of my day to day stuff. Interesting shifts and/or calls, and maybe even some educational stuff. I hope to leave my mark in the medical field.

*****Update September 13, 2009*****

As you can probably tell, this blog has taken a whole different direction than initially intended. This job is my passion, and so is education. I felt that a multi-authored prehospital education resource would be pretty beneficial. I hope you enjoy.

*****End Update*****