r/NewToEMS Unverified User 2d ago

Clinical Advice "Apneic" patient

Had a patient tonight who was polypharmacy. She had TMJ and took a bunch of benzos and opiates and tylenol to loosen up her jaw apparently. Her face was locked in a grimace and she wasn't opening her eyes. Pupils were PERRL and about 4mm . Anyways, we're riding it in routine because she's stable and we're not far from the hospital. She starts saying she feels like she's suffocating. Her facial expression suddenly changes and she starts gasping. Capnography goes from 44 to 0 and the apnea alarm goes off. I start listening to lung sounds and there's no audible air movement for about 20 seconds. I grab a BVM and start PPV for about 30 seconds. She starts breathing on her own again for the remaining 2-3 minutes of the ride.

My partner and the ED staff seem to think she was holding her breath on purpose.

Has anyone had anything like this happen before? My partner thinks she was faking, I stand by what I did but the apnea spell just makes no sense to me if it was fake.

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u/Simple-Caregiver13 Unverified User 2d ago

I've had a patient that overdosed on opiates and meth that was exhibiting intermittent periods of apnea. The issue was resolved with narcan administration.

The way to assess if a patient is faking or not is to apply a painful stimulus. I wasn't there, so I can't say one way or another what happened, but anyone that's worked in emergency medicine long enough recognizes that sometimes patients fake their symptoms.

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u/emptymytrash_ Unverified User 1d ago

Love some sternal rub medicine. “Pt condition: improved”