Chair

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Story for team:
Dispatch centre received emergency call:
25 years old man found in kitchen by wife, 2 minutes unconscious, may have been a whole-body seizure, now confused, happened first time. Call by spouse.

Your task is::
• examination
• working diagnose
• way of transport and routing

Local situation:
A Nearest hospital is 20 km by ground transport with surgery, internal medicine, anaesthesia and general intensive care dept., neurology, gynecology and obstetric, CT scan and  biochemistry.
B Higher level hospital 42 km by ground transport, dept. as A + ED, ENT, oncologic dept., psychiatry, infectious diseases and pediatric dept.
C Specialized centre 55 km by ground. Depts. as B + traumacentre, burn unit, cardiocentre, stroke unit, NMR.
D Helicopter rescue available at 15 mins.
 
Description:
Young conscious man, sitting in kitchen, desorientated by all means, patient ́s history without previous complicating diseases, does not remember the situation, last, what he does remember is pouring water from a tea kettle into a cup.

He refuses treatment, insists on signing transport refusal. After repeated and detailed explanation agrees to be treated and transported to medical facility.

Physical examination:
GCS 4-4-6, SpO2 99 %, glycaemia 5,8, mmol/l, BP 160/100, neurological without lateralization, teeth bites on tongue, P 160/irreg, breathing sounds clear, no abnormal phenomena,abdomen normal finding, no hepato and splenomegaly, legs without oedema, small point burns on 2 fingers of right hand.

ECG: SVT 160/min, polytopic ventricular extrasystolas, phenomenon R on T, depression ST-T I, aVL, V1-6
Point of task:
rovide pre-hospital emergency care. Assessing situation, complete retrieval of patient history, detailed physical examination, differential diagnostics and identification of electric  current strike. Solve situation where patient endangered by malignant arrhytmia and other complications refuses treatment and insists on signing treatment refusal against medical advice.