Wednesday, June 11, 2014

Man's Grave or Man-hole?



We respond to a call for breathing difficulty to find a lady who is lonely and breathing just fine. She denies having any chest pain shortness of breath, abdominal pain or a head ache. Her vital signs are within normal range. The primary and secondary exam is unremarkable. As the Company Officer I am monitoring radio traffic and hear a call being dispatched in our response district for a man unconscious in a man hole. I advise the paramedics on the ambulance that the engine is going to clear and respond to the next call. They can stay on this scene until they call the hospital and get a release from the emergency room doctor.
My engineer driver and I quickly clear the scene and respond to the call along with another ambulance from the downtown station. We arrive first to find the supervisor pulled the man out of the man hole and he is now on the ground still unconscious. We quickly assess the patient and find he has a pulse and is breathing. He only responds to painful stimuli and the supervisor advises us he was in the man hole using a gas powered saw. The only fresh air he had was supplied through a 1/4 inch air hose from an air compressor on the truck. He further advises us that he (the supervisor) went into the man hole to pull the other worker out. Both individuals are assessed using a sensor that reads blood CO levels through a finger probe. The unconscious patient has readings of 38-40% and the supervisor has readings of 12-18%.Supplemental oxygen is given to both patients with a non-rebreather mask at 15 letters per minute.

We now have two patients, patient A is unconscious and patient B has also been exposed to high levels of CO. As part of the scene survey we get a quick CO reading in the man hole, we stick a small tube into one of the small hole of the man hole cover and get a CO reading of 300-350ppm. A very dangerous place to be working with insufficient fresh air. As discussed in an earlier post, CO binds to the blood hemoglobin and takes the place where O2 molecules normally adhere. This means the blood cannot deliver needed oxygen to cells throughout the body including the critical areas of the brain, heart and lungs.
Patient A starts to regain consciousness but he is combative and uncooperative. After his supervisor explains he will lose his job if he refuses to go to the hospital he reluctantly agrees to go. He and his supervisor are loaded into the ambulance where oxygen therapy is continued and an IV is established for patient A. After arrival in the emergency department the doctor performs a quick assessment and sends patient A for hyperbaric treatment. This will speed the process of releasing the CO from the blood hemoglobin and allow the oxygen its rightful place. A close call that could have ended in a tragedy. A related post.

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