By JD Postage
Firefighter/Paramedic
In November 2006, Medic 593 was called out for an ill person at a local restaurant. Upon arrival, the patient was found sitting in back of a police car. He had been driving erratically and ended up striking a parked car and trash can in the restaurant parking lot. The patient was alert but very confused, complaining of a headache, nausea, vomiting, weakness and dizziness. The patient’s physical exam was normal, with no signs of trauma. His vital signs were as follows: BP 110/60, heart rate 106, respiratory rate 36 with some accessory muscle use.
At this point, I knew what was wrong with the patient- it was hypoglycemia, with the possibility of a medication overdose. A check of the patient’s blood sugar quickly proved me wrong. His sugar was 232 mg/Dl. We thoroughly searched the patient and his car for any signs that might support an overdose. There was nothing. We were back to square one, which was nowhere.
We had tried everything we could think of to determine why this patient was so altered, each time coming up blank. Then someone suggested we try "that new piece of equipment". The RAD-57 had been put into service a couple of weeks before this call. I was not one of its biggest fans, considering it to be just one more thing we had to carry around on the truck with us, taking up space. However, as we had gone through everything else with this patient, I didn’t think it could hurt. Within 20 seconds, the RAD-57 had changed the entire direction of the call.
The patient had a carboxyhemoglobin level of 40% with a SpO2 of 94%. Now we knew exactly what was wrong with the patient. We immediately began treatment the CO poisoning with high flow O2. With the patient’s condition under control, we needed to find out where the source of the CO was, in case there were others who were being poisoned along with the patient. The problem was that we still did not know who this patient was or where he had come from. As it happened, the patient had crashed in the parking lot of a restaurant he frequented. Some of the staff had come out to see what was going on and they were able to tell us his name, address and that he had a disabled wife at home.
As the patient left for the hospital, we had another engine respond to check the patient’s house and wife elevated CO levels. Fortunately, there was no CO found in the patient’s residence and the wife was OK. The source of the CO was attributed back to a bad exhaust system on the vehicle the patient had been driving.
There was nothing about this patient, as he presented to us, which would have led us to suspect CO poisoning. If not for the RAD-57, he would have been just another ‘altered mental status with unknown cause.' We would have taken him into the ED where it is likely they would not have discovered the true cause of the patient’s condition, as there was no history connected with him to make carbon monoxide an obvious diagnosis. He would have been released from the ED back to his poisoned home environment.
The treatment for CO poisoning in the field is oxygen. That’s the easy part. It is a matter of detection. Can you tell if it is food poisoning, the flu, a headache or is it actually CO poisoning? What about when your patient is too confused to appropriately answer your questions? The RAD-57 took the guess work out of it for us. I thought it was just one more piece of equipment until I saw what a difference it made on this call. Now I wouldn’t be without it.
The Violet Township Fire Department is located in Pickerington, Ohio approximately 20 miles outside of Columbus in Fairfield County. Our coverage area is 42 square miles, serving 30,000 residents in the town of Pickerington and parts of Canal Winchester and Reynoldsburg. We have 39 career firefighters, 22 part-time and 12 volunteer personnel who respond to ~4,000 medical and fire calls per year. The department runs 4 ambulances and all engines are ALS equipped.
