Prehospital improvisation of standard oxygen therapy equipment to facilitate delivery of a bronchodilator in a supine patient

Abstract

A police request was made to the ambulance service to attend an adult victim of an alleged assault. On arrival the patient was found to be alert (AVPU: alert, responds to verbal stimuli, responds to pain, unresponsive), in a seated position, and complaining of head, neck and back pain. The airway was clear; a mild diffuse polyphonic wheeze was noted bilaterally throughout both lungs. Respiratory rate was 16 bpm and heart rate was 126 bpm. Oxygen therapy was commenced via a duo mask (fractional inspired oxygen (FiO2) 0.53) as oxygen saturation was recorded initially at 94% on air. The mechanism of injury caused concern regarding possible c-spine injury as the patient's head had been struck forcefully against the wall. The patient denied any loss of consciousness. Bony tenderness was elicited during c-spine examination and a c-spine collar was applied with full spinal precautions. The patient was immobilised using a long board, head huggers and straps to facilitate removal to the ambulance. Acute alcohol intoxication enabled only a vague medical history but inferred alcohol misuse and smoking. https://emj.bmj.com/content/29/11/921. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emj.2011.111666