Posted by Unit 122

http://www.wgrz.com/news/local/story.aspx?storyid=79101&catid=37

Very interesting, I had someone this week who was .17, and the cop vehemently disallowed an on scene assessment in favor of rushing the patient to the station to do the breathalyzer so he could nail him on the DWI.

The call was an MVA with a significant MOI involved, and the officer was clearly wrong from a medical standpoint – the front end of the car was obliterated, and a full C-spine was called for. This law makes sense beyond the obvious legal ramifications since it gives medics leverage over any other responding entity who has interests other than patient care in mind. A simple blood draw can ensure that the law-enforcement side of things are covered, and we can then focus on patient care having taken care of the BAC issue.

However, I believe that this would need to be approved by the agency Medical Director, since REMAC protocols only currently indicate blood drawing on standing orders by Cyanide/Smoke Inhalation before Hydroxocobalamin (yes, that was a test question). The GOP states that any other blood drawing would be a discretionary decision made by the agency Medical Director.

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Dr Trowers

Epidemiology

• over 4 million poisonings annually
• 10% of ED visits and EMS responses
• 70% of accidental poisonings occur in children under 6 years old
• 80% of attempted suicides involve a drug overdose

Routes of Exposure

• Ingestion

• Household products
• Petroleum based
• cleaning agents
• cosmetics
• drugs, plants, or foods
• absorption occurs in stomach and small intestine

• toxic gases, vapors, fumes, aerosols (cyanide)
• carbon monoxide, ammonia, chlorine
• tear gas, Freon, nitrous oxide, methyl chloride
• carbon tetrachloride
• absorption occurs via capillary-alveolar membrane in the lungs
• SCENE SAFTEY IS PARAMOUNT – DO NOT GO IN WITHOUT PROPER PPE

• recognize poisonings promptly
• assess patient thoroughly to id the toxin and measures to control it
• initiate standard treatment procedures

• protect rescuer safety
• remove patient from toxic environment
• support ABCs
• monitor vitals signs closely
• reduce intake (wash skin, remove from environment, activated charcoal, etc)

• involve law enforcement
• involve medical control
• know local procedures and laws

• what
• when
• how much
• did you drink alcohol
• have you attempted to treat yourself
• have you been under psychiatric care? Why?
• what is your weight

To be continued…….