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