Enrоute phаseScenаriо:The pаramedic unit is dispatched tо a residential care facility for an 82-year-old male who is experiencing difficulty breathing and is unable to lie flat. The call was received at 0915. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also responding. It is a cool fall morning, 48°F (9°C), with overcast skies and light traffic. According to staff on scene, the patient has a history of heart problems. They report the patient was doing well earlier in the day but became increasingly short of breath after breakfast and now appears pale and anxious.OnScene phaseScenario:The patient (approx. 75 kilograms) is found sitting upright in a recliner, visibly dyspneic and anxious. He is gasping for air, speaking in one- to two-word sentences, and using accessory muscles to breathe. Lung sounds are diminished with bilateral crackles. The patient has jugular vein distension and pitting edema in both lower extremities. He is pale and diaphoretic. Staff report that the patient missed his morning doses of furosemide and metoprolol. Initial vital signs: BP 178/96, HR 118 (irregular), RR 30, SpO₂ 86% on room air, Temp 97.6°F (36.4°C).What medication would be appropriate for this patient if systolic blood pressure remains >100 mmHg and no contraindications are present?
Enrоute phаseScenаriо:The pаramedic unit is dispatched tо a residential structure fire for a 42-year-old male reportedly burned while attempting to extinguish flames in his kitchen. The call was received at 0758. Estimated response time is 7 minutes. The paramedic is partnered with an EMT, and a BLS engine company is also responding. The outside temperature is 62°F (17°C) on a clear spring morning. According to fire personnel on scene, the patient has burns to the chest and arms and was exposed to smoke for several minutes before exiting. He is reported to be conscious but in significant pain.OnScene phaseScenario:The patient (approx. 85 kilograms) is alert and seated outside the home. He has partial-thickness burns across the anterior chest, both forearms, and hands, with blistering and severe pain. His eyebrows and nasal hairs are singed, and he has a persistent cough. He is hoarse and has soot around the mouth and nose. No other trauma is observed. The patient reports using a fire extinguisher and then evacuating himself. He is anxious and asking for help.Initial vital signs: BP 134/88, HR 126, RR 28, SpO₂ 94% on room air, Temp 99.1°F (37.3°C), Pain 9/10. PostScene phaseScenario:The patient is transported in a position of comfort on high-flow oxygen. IV access is established, and fluid resuscitation is initiated per Parkland formula guidelines. The patient’s pain is treated with fentanyl titrated to effect. He remains alert but becomes more hoarse en route and develops increased work of breathing. Vital signs are monitored continuously. A burn center consult has been requested via online medical direction. Updated vitals: BP 128/82, HR 112, RR 32, SpO₂ 92% on oxygen, Temp 99.4°F (37.4°C), Pain 4/10 after treatment.Which of the following should be included in the handoff report to the receiving facility?
Enrоute phаseScenаriо:The pаramedic unit is dispatched tо a residential care facility for an 82-year-old male who is experiencing difficulty breathing and is unable to lie flat. The call was received at 0915. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also responding. It is a cool fall morning, 48°F (9°C), with overcast skies and light traffic. According to staff on scene, the patient has a history of heart problems. They report the patient was doing well earlier in the day but became increasingly short of breath after breakfast and now appears pale and anxious.OnScene phaseScenario:The patient (approx. 75 kilograms) is found sitting upright in a recliner, visibly dyspneic and anxious. He is gasping for air, speaking in one- to two-word sentences, and using accessory muscles to breathe. Lung sounds are diminished with bilateral crackles. The patient has jugular vein distension and pitting edema in both lower extremities. He is pale and diaphoretic. Staff report that the patient missed his morning doses of furosemide and metoprolol. Initial vital signs: BP 178/96, HR 118 (irregular), RR 30, SpO₂ 86% on room air, Temp 97.6°F (36.4°C).PostScene phaseScenario:The patient is placed on CPAP with 100% oxygen, and his respiratory rate gradually decreases. He is transported in a high Fowler’s position. During transport, an IV line is established, and nitroglycerin is administered per protocol. The patient remains alert but fatigued and continues to complain of shortness of breath, although less severe. Lung sounds are still wet, and ECG shows atrial fibrillation at a rate of 112. Updated vitals: BP 152/84, HR 112 (irregular), RR 22, SpO₂ 94% on CPAP, Temp 97.9°F (36.6°C). What documentation is most important to include in the hospital handoff report for this patient?