2005 EMT-Intermediate Curriculum

In-Class Critical Thinking Scenario

You are dispatched to a “man down, unknown problem” in a suburban neighborhood on a late fall afternoon. You pull up to a one-story residence and notice a ladder leaning up against the side of the house.

An approximate 55 year-old male, “Dave,” is lying supine on the couch with a wet rag on his forehead. His wife is kneeling next to him. Dave is conscious but is slow to answer questions. His skin is pale. His wife tells you that she came home from the grocery store and found Dave on the floor of the living room. She states “he didn’t look right.” She assisted him to the couch and called 911. You notice a bump on his forehead when you remove the wet rag.

Based upon your assessment so far, list the potential causes for this call.

List the typical assessment findings you would expect to see with each potential cause.

You continue with your initial assessment and find that Dave’s breathing is unlabored with a respiratory rate of 20 with occasional sighing. His radial pulse is present at a rate of 80. His pulse occasionally skips a beat or two. Dave is able to answer questions appropriately but hesitates before answering. He complains of a “nasty headache.”

Rate the severity of his condition on the following scale:

______

Life-threateningModerately acuteNon-life threatening

Circle the information from the assessment findings on this page that lead you to this decision.

List the treatments or interventions you would perform at this point.

Dave has a past medical history of Type 2 diabetes, hypertension and a “mild” heart attack 3 years ago. He last visited his doctor 2 weeks ago and had some changes to his blood pressure medication and diabetes medication.

Can a “nasty headache” be caused by a problem with diabetes and/or hypertension? How? Briefly explain your answer.

Dave tells you that he was cleaning out the gutters this afternoon when he had a sudden onset of a headache. His vision became blurry and he felt nauseated. As he attempted to get off of the ladder his foot slipped and he fell approximately 5 feet, landing on the lawn. He slowly made his way back into the house and waited for his wife to come home.

Review your list of potential causes from question #1 and modify it using the additional information from question #3.. Select the top 3 probable causes for this patient so far.

List the specific assessment findings that would typically be present with each new potential cause.

Further assessment reveals the following: BP 198/100, pulse oximetry of 99% on oxygen and a CBG of 64. ECG reveals a sinus rhythm with occasional PVCs.

Your focused physical assessment reveals the following:

No other injuries to the head; no bruising to the eyes or behind the ears; pupils are equal and reactive
Mild neck tenderness
Abrasion to the patient’s left shoulder
Tenderness to compression of his left lateral rib cage with bruising; no crepitus noted and lung sounds are clear bilaterally
Abdomen is soft and nontender; no bruising noted
Abrasion noted to the left hip area; pelvis is stable with compression
Abrasions to his left lower leg and left arm; no other obvious injuries; both hands are shaking

Describe your treatments and any follow-up assessments you would perform at this point.

You are finished with the call and you are writing your chart. What would you list as your field impression or list under “A” in your SOAP chart?