male teaching case #1 mr. kruski 45 y/o 180 lbs

MALE

Teaching Case #1

Mr. KruskiMr. Kruski

45 Y/O

180 lbs.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

DispatchDispatch8550: “Dispatch, 8550 is on the air”

Disp: “8550, a fall, code 3 at the Minneapolis/St. Paul airportBuilding B. Northwest Airlines.”

8550: “Received, responding Building B”

Disp: “Incident 48754, time out 1030 hours,45 year old male, Conscious and Alert. Patient is pinned under construction equipment.”

8550: “Received, thank you”

8550: “Dispatch, 8550 is on the air”

Disp: “8550, a fall, code 3 at the Minneapolis/St. Paul airportBuilding B. Northwest Airlines.”

8550: “Received, responding Building B”

Disp: “Incident 48754, time out 1030 hours,45 year old male, Conscious and Alert. Patient is pinned under construction equipment.”

8550: “Received, thank you”

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

Scene/MOIScene/MOIYou arrive on scene to find:

a man laying supine. His coworkers state he was struck by a falling barrel that weighs approximately 800lbs. The barrel fell from a height of approx. 10 feet. They removed the barrel before you arrived.

You arrive on scene to find: a man laying supine. His coworkers

state he was struck by a falling barrel that weighs approximately 800lbs. The barrel fell from a height of approx. 10 feet. They removed the barrel before you arrived.

SceneScene

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

InterviewInterviewIntroduce yourselfWhat question would you like to ask?

• Do you have any allergies to medications?

• Do you take medications?• What is your past medical history?• When did you eat your last meal?• What events led to you to call us?• More HPI questions (OPQRST)?

Introduce yourselfWhat question would you like to ask?

• Do you have any allergies to medications?

• Do you take medications?• What is your past medical history?• When did you eat your last meal?• What events led to you to call us?• More HPI questions (OPQRST)?

InterviewInterview

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

IntroductionIntroductionEMS: Hello, my name is Jane EMT and I will be

taking care of you today Mr. Kruski. What happened?

PATIENT: Thank you for introducing yourself… aah my hips hurt.

EMS: Mr. Kruski, did you loose consciousness?

PATIENT: No and please call me Bernie…

<Pt. Is not able to move>

EMS: Hello, my name is Jane EMT and I will be taking care of you today Mr. Kruski. What happened?

PATIENT: Thank you for introducing yourself… aah my hips hurt.

EMS: Mr. Kruski, did you loose consciousness?

PATIENT: No and please call me Bernie…

<Pt. Is not able to move>

Courtesygoes a longway, doesn’t it?

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

HPIHPIWhat question would you like to ask?

• When did your symptoms start?• What were you doing when this began?• Is it a sharp or dull pain?• Does it radiate or go anywhere?

• What have you done to make yourself feel better?

What question would you like to ask?

• When did your symptoms start?• What were you doing when this began?• Is it a sharp or dull pain?• Does it radiate or go anywhere?

• What have you done to make yourself feel better?

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: OnsetOPQRST: OnsetInjuries occurred after a barrel

fell on top of the patient. The patient denies Loss of Consciousness.

Injuries occurred after a barrel fell on top of the patient. The patient denies Loss of Consciousness.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: ProvocationOPQRST: Provocation

“Like my co-worker said: A barrel fell on top of me, you don’t listen very good do you?”

“Like my co-worker said: A barrel fell on top of me, you don’t listen very good do you?”

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: QualityOPQRST: QualityConstant and sharp. Constant and sharp.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: RadiationOPQRST: Radiation• Mr. Kruski: “No it is just in my

hips. Please help me.”

• Mr. Kruski: “No it is just in my hips. Please help me.”

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: SeverityOPQRST: Severity• 10 over 10. Mr. Kruski

answers questions very slowly and in a low tone of voice. He is starting to feel groggy.

• 10 over 10. Mr. Kruski answers questions very slowly and in a low tone of voice. He is starting to feel groggy.

1 5 10

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

OPQRST: TimeOPQRST: Time• Injury occurred only a minute

or two before EMS was called.

• Injury occurred only a minute or two before EMS was called.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

AllergiesAllergies• Mr. Kruski: “I get terrible

hayfever, I think it’s the pollen and ragweed”

• Mr. Kruski: “I get terrible hayfever, I think it’s the pollen and ragweed”

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

MedicationsMedications• I don’t take drugs of any kind. My

doctor Katheryn Richards doesn’t believe in that stuff.

• I don’t take drugs of any kind. My doctor Katheryn Richards doesn’t believe in that stuff.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PMHPMH• None• None

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

Last MealLast Meal• Pt. Can’t remember.

• His coworkers say he always has breakfast with them but he didn’t show up this morning because he has an errand to run at Target.

• Pt. Can’t remember.

• His coworkers say he always has breakfast with them but he didn’t show up this morning because he has an errand to run at Target.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

Events Leading to Present IllnessEvents Leading to Present Illness

• Pt.’s coworker:“ We were moving some barrels on the shelves. We should have been using a forklift but we were in too much of a hurry.Do you think he’s going to be OK?I’m very sorry… REALLY sorry.”

• Pt.’s coworker:“ We were moving some barrels on the shelves. We should have been using a forklift but we were in too much of a hurry.Do you think he’s going to be OK?I’m very sorry… REALLY sorry.”

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

Physical ExamPhysical Exam

ExamExam

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: HEENTPE: HEENT• No sternal notch retractions

• trachea midline

• Clear of fluids

• No JVD

• PERL

• Skin is pale, clammy, cool

• No sternal notch retractions

• trachea midline

• Clear of fluids

• No JVD

• PERL

• Skin is pale, clammy, cool

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: CHESTPE: CHEST• No tenderness or abnormality

on palpation

• Chest Rise is equal

• No use of accessory muscles

• Clear, Equal Bilat. Lung Sounds

• No tenderness or abnormality on palpation

• Chest Rise is equal

• No use of accessory muscles

• Clear, Equal Bilat. Lung Sounds

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: EKGPE: EKGMonitor shows:Monitor shows:

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: Neck/BackPE: Neck/Back• No deformities, discoloration,

tenderness.

• No deformities, discoloration, tenderness.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: Abd./PelvisPE: Abd./Pelvis• Soft

• No masses

• Non-Tender

• Pelvis is unstable.

• No crepitus.

• Extreme pain on palpation.

• Soft

• No masses

• Non-Tender

• Pelvis is unstable.

• No crepitus.

• Extreme pain on palpation.

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: ExtremitiesPE: Extremities• No sensation or movement

bilaterally below the level of the waist. Pedal pulses are thready but present.

• Capillary refill is delayed in finger.• Handgrips strong and equal.• No Pedal Edema

• No sensation or movement bilaterally below the level of the waist. Pedal pulses are thready but present.

• Capillary refill is delayed in finger.• Handgrips strong and equal.• No Pedal Edema

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: Vital SignsPE: Vital SignsCurrent Vitals are:Current Vitals are:

Time BP P R Qual Sa02 LOC 1038 108/70 128

IRR 24 NL 98% A

1045 100/p 120 24 NL 98% V

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

PE: DiagnosticsPE: Diagnostics• Glucometer: Not Obtained

• End Tidal CO2: Not performed

• Glucometer: Not Obtained

• End Tidal CO2: Not performed

DiagnosticsDiagnostics

InterviewInterview ExamExam

ToolsTools

SceneScene

Pt. InterventionsPt. Interventions

Pt. InterventionsPt. Interventions• Mr. Kruski’s coworkers have

been holding his head and trying to keep him still.

• The 800 pound barrel has been removed.

• Mr. Kruski’s coworkers have been holding his head and trying to keep him still.

• The 800 pound barrel has been removed.

Pt. Interv.Pt. Interv.