ERDoc

So really, you can't make any conclusions based on the data. Sounds like we need a study with better power. Do you have an up to date link for the study?

I can't pull up the actual study, but are those results statistically significant?

LOL. I think the EMS gods are going to strike me down.

Phlebotomy is an accepted treatment for polycythemia vera.

I'm going to echo what the wise ones before me have said. I will add one thing. If you are a volley, DO NOT wear any volley gear (jacket, hat, shirt, etc).

I agree with systemet, I think we all have a different picture of what this pt looks like. I would not be very aggressive with treating the BP, especially in the field. There is no urgent need to fix it, especially since we don't know what the pt normally runs. This could be her normal for the last few months and dropping it precipitously will cause problems. She certainly needs evaluation for end organ damage in the ER, but I think from the field perspective your best bet is to monitor and transport. Treating her headache wouldn't be a bad idea. I would avoid toradol because she has a motrin allergy and because we haven't ruled out a bleed yet. Otherwise, it would be appropriate. Morphine would be fine. I would give this woman an extra dose of her lisinopril and work her up. If we get her feeling better and there is no end organ issues, I would call the PMD and see what he wants to adjust. If there is end organ damage, obviously we will need to up our game a bit.

I wouldn't put too much on the sodium, it is just under normal. Hard to say why he was hypokalemic. It was replaced and never an issue again. His lactic acid was elevated at 2.7 which is probably the cause of the acidosis.

It was an interesting case. It would have been so easy to just say that it was his tooth and send him on his way. It was the temp that made me take a second look and start a work up. Always question abnormalities. In the end, the working diagnosis right now is that he smoked some marijuana that was unexpectedly laced with something, which caused a vasculitis which bled. Still no explanation for the sepsis/SIRS.

Are you saying DD had multiple accounts, like ventmedic? lol

So when did you start modeling? Gotta say though...you could have put the pads in the right place...

Sun's out, guns out. It was hard to put the pads in the right place when my eyes were directed elsewhere.

No history of migraines. You obtain a rectal temp and it is 35.4. The pt has not been outside. Labs:

Na 131

K 2.4

Cl 114

CO2 20

BUN 17

Creat 0.64

Glucose 107

WBC 14.7

Hgb 17.3

Hct 48.7

Plt 286

CT of the head shows a left frontal subarachnoid bleed

Since this case seems to have died, I guess we will end it. Due to the amount of pain that the pt is experiencing, a CT is ordered and shows calcific tendonitis of the longus colli muscle. It's not common and can often mimic some pretty serious things such as retropharyngeal abscesses. If the swelling is severe enough it can interfere with proper speech. Treat is with anti-inflammatories.

Come on, it's an advertising photo. He wanted to show off his sweet pecs to the girl in the photo. They wouldn't let him whip out the guns.

He is A&OX3/4, No -rhea, Normal neuro exam. There have been a few good ideas, but let's develop a full differential.

Your 12 lead is normal.

Contents of the vomit are unremarkable. This was the first episode. He is missing a few teeth. The painful tooth is the left upper wisdom tooth, which is fractured at the gum (not a new finding). There is no gum swelling and mild pain with percussion of the tooth. No bleeding, pus or other abnormalities. He has had episodes of pain with the tooth before, but has never had a headache like this. No sick otherwise, no history of drug use/abuse. Your fancy ambulance has access to hospital records and the state drug database, both of which are unremarkable. No medical problems or medications other than some Motrin he's been taking for the tooth pain.

P88 BP 143/90 RR 18 SpO2 99% on room air, skin is cool to the touch and dry. Tympanic temp is 35.2C. He is pulling the blanket over his head because the light bothers him

Any movement hurts and when you stand to his side, he will only turn his eyes to look at you. Movement of either shoulder also hurts. He's a rural farmer so he is pretty tough. IV toradol offers him some relief. C-spine xrays are normal but he is still painful.

You are called to the house of a 39y/o male at 4am for dental pain. He tells you that is left upper wisdom tooth has been bothering him for 3 days. It woke him up this morning and while he was using some mouthwash he developed a severe headache which is why he called you. As you walk in the room he has one episode of vomiting.

How hot was the rice pack and how long did he have it on? If he really burned himself that badly it was either very hot or he has a problem with the tissue in his neck, localized paralysis, degenerative disease of some sort or something along those line. Or...the pain is just due to the burn and this is all a red herring...

He said it was pretty hot and burned when she put it on. He thought about taking it off but wanted relief from he pain that was present before the burn

Could be a spider bite as well if that's a problem in that part of the country.

No, it's not MRSA

At 71 he shouldn't be shoveling snow. How much snow & for how long?

He shoveled his driveway which took him about an hour.

Is he having muscular contractions or spasms in his neck or shoulders?

Nope

how are the tendons in his neck soft & pliable or taut?

Normal for a 71y/o

My gut is going with muscoskeletal strain , but to be sure I think further checking is needed.

How deep is the burn? 2nd or 3rd degree?

Mostly 1st degree with the 1cm by 3cm area of 2nd degree

sounds like she nuked the rice bag and didn't test it to see how hot it was before wrapping it on his neck.

Sounds about right

what physical activity was he doing the day or two before the pain started?

where specifically is the pain centered ? structural or muscular?

any vision or speech issues?

as always vitals and full exam

He was shoveling snow earlier in the day but doesn't recall any injuries or pain. He points to the area of C4 down to C7 as the area of pain. No vision or speech issues. HR 80, BP 148/88, RR 14 SPO2 99% on room air. The pt has pain with palpation to the area where he says it hurts. No step offs. There is a 4" by 3" red area centered over the painful area with a broken blister to the left side measuring about 1 cm by 3 cm. He tells you it is from a hot rice pack his wife made him for the pain.

Clearly ebola. Run away.

Close, but it is actually herpegonosyphilitis.

A 71 y/o male calls due to progressively worsening neck pain over the last 24 hours. He is unable to move his neck due to the pain. He has no medical history, surgical history or allergies. He takes no meds on a regular basis but has been taking some motrin for the pain with some relief.

Fair enough, but if you are talking about medical malpractice/negligence, this case does not meet the legal definition. Just because something is unethical doesn't make it illegal, which is why we have so many lawyers on the streets.

What? I couldn't hear you over my phonograph! HPG, stick around and contribute. You will find that there is a lot to learn here, once you cut through all of the bad jokes.

Can I ask that your treatment be supported with evidence?

ERDoc, im not sure whether seniorcare is either of those but i know transcare is separate from seniorcare, although don't take my word for it because im a newbie to ems. well the first 3 digits for mine are 462

Congrats on the job! Looks like seniorcare and transcare are separate. 462? Damn, I feel old.