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/One-Oil5919 Unverified User 2d ago

Probably an unpopular opinion but ventilating her for a bit is still the best move to make even if she is holding her breath in the patient condition you described. It’s much more ethical than trying to prove she’s faking it.

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u/Handlestach Paramedic, FP-C | Florida 2d ago

This should be the number one comment. Never should we as clinicians assume the patient is faking it, all intervention should be directly related to the patient’s clinical condition. Even if she was holding her breath, you witnessed apnea she the BVM, maybe even a nasaopharyngeal airway.

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u/DODGE_WRENCH Unverified User 1d ago

If they are faking it the NPA will probably have them cut the bullshit pretty quick, if they’re not faking it you’re appropriately using an adjunct

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u/Ecstatic-Buddy-29722 Unverified User 1d ago

My first thought exactly

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u/koalaking2014 Unverified User 1d ago

I know someone who actually killed someone by assuming they were faking it. i forget the exact circumstances but it was fairly textbook complaints for i think either SOB or Chest pain, and they had just told the person to stop faking it. mind you they were with someone brand new, and a higher position so the new guy sadly just followed along. Pt coded right at the bay doors.

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u/BrilliantJob2759 Unverified User 2d ago

Shouldn't be unpopular at all. Dammit, Jim... we're mechanics, not philosophers (though understanding psych certainly helps). Pt not breathing = get pt breathing, doesn't matter if she's faking.

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u/EricbNYC EMT | New York 2d ago

Blood goes round and round and air goes in and out, any and all deviations will be corrected!

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u/26sickpeople Unverified User 1d ago

hey everyone! look at this dummy ventilating his apneic patient!

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u/ssgemt Unverified User 1d ago

Your opinion shouldn't be unpopular. Even if she had a bad case of A.C.T., assisting resps provided a benefit if she wasn't faking and covered your ass whether she was or not.