ERDoc Posted April 19, 2006 Share Posted April 19, 2006 You are called to the house of a 43 y/o female by her husband. He has just returned from a family emergency out of state and found his wife unable to see and a bit confused. What else do you want to know? Link to comment Share on other sites More sharing options...
Ridryder 911 Posted April 19, 2006 Share Posted April 19, 2006 sudden onset.. versus slow, curtain shade description, bright objects, painful, H/A, peripheral vision, pupillary reflex.. retinal detachment vs occulusion or cerebral bleed.. or the old hysterical conversion ? R/r 911 Link to comment Share on other sites More sharing options...
ERDoc Posted April 19, 2006 Author Share Posted April 19, 2006 sudden onset.. versus slow, curtain shade description, bright objects, painful, H/A, peripheral vision, pupillary reflex.. retinal detachment vs occulusion or cerebral bleed.. or the old hysterical conversion ? R/r 911 Pt is not able to answer questions well, but from what you can get from her the vision loss was gradual. It started centrally and has progressed outward over the period of 2 days. No headaches or eye pain. There is complete loss of all visual fields. Pupils are fixed and dilated. I think this puts conversion higher on the ddx . Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2006 Share Posted April 19, 2006 Can we get any medical history on the patient? Does she take any medications or have any history of trauma? I would also like to get a set of vital signs and a blood sugar. I am thinking out loud about the ddx's; Allot of obstructive causes of vision loss result in sudden onset not gradual over days. Perhaps an atypical presentation of glaucoma, acute closure with no pain or undiagnosed chronic angle closure. I know a fixed pupil in mid position with vision loss may suggest angle closure. History of methanol ingestion? I also know this can cause vision loss and fixed/dilated pupils. This may help us reach a diagnosis. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted April 19, 2006 Author Share Posted April 19, 2006 Can we get any medical history on the patient? Does she take any medications or have any history of trauma? I would also like to get a set of vital signs and a blood sugar. I am thinking out loud about the ddx's; Allot of obstructive causes of vision loss result in sudden onset not gradual over days. Perhaps an atypical presentation of glaucoma, acute closure with no pain or undiagnosed chronic angle closure. I know a fixed pupil in mid position with vision loss may suggest angle closure. History of methanol ingestion? I also know this can cause vision loss and fixed/dilated pupils. This may help us reach a diagnosis. Take care, chbare. Your pt is a former heroin abuser and also has a h/o htn, herniated lumbar disk with chronic back pain and Hep C. There is no h/o trauma. She is taking atenolol, norvasc, quinine, oxycontin, robaxin, motrin, methadone, lasix and Kdur. FS is 106. 114/68 68 14 98.2. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2006 Share Posted April 19, 2006 Quinine toxicity may account for the blindness and confusion. Has she taken more than her perscribed doses of medications or more than her usual doses of meds? chbare. Link to comment Share on other sites More sharing options...
medik8 Posted April 19, 2006 Share Posted April 19, 2006 Hmmm....Retinal detatchment, retinopathy, glaucoma, brain tumor/bleed, medication, temporal arteritis, ....Norvasc..usually helps restore sight..reattaches retinas....hmmm... I'm gonna say check the Quinine level....possible OD...Quinine can cause temporary blindness.....It can also cause low blood sugar...which could explain the confusion... xoxoxo 8 Link to comment Share on other sites More sharing options...
medik8 Posted April 19, 2006 Share Posted April 19, 2006 DAMMIT...someone beat me to it! Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2006 Share Posted April 19, 2006 I think we may be on to something with the quinine medik8. However, I cannot rule out other causes with the information I have. Does the patient c/o tinnitus? Is there a history of cinchonsim related to the quinine use, or a history of G-6-PD deficiency? (I hope there is no hx. of G-6-PD deficiency, but you never know) I doubt we would be able to obtain this info in the field, but you cannot go wrong trying if the situation permits. At this point I think transport would be a good idea. Put the patient in position of comfort , give her supplemental oxygen, establish an IV life line, and put her on the monitor. She may be prone to cardiac rhythm disturbances if this is in fact related to quinine, or any number of medical problems on that note. Hopefully this will help us get to the bottom of this case. chbare. Link to comment Share on other sites More sharing options...
RaceMedic Posted April 20, 2006 Share Posted April 20, 2006 IS the Quinine a new script ? what is her ethnic background ? Link to comment Share on other sites More sharing options...
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