brock8024

I would like to know the path the bullet took. THis is going to let us know really fast what we need to do. I am with everyone else. I am torn between oral and surgical airway.

Here is my question. If the bullet took the right path and you can see the trachea could you just use the hole the bullet made. I know this sounds stupid and I might come under fire but if there is already a hole and I can see and know that is the trachea why not use that hole.

Ok if the bullet went in anterior aspect of the neck that wound involve the trachea, and big vessels. If it went more posteriorly it would involve big vessels and the spinal cord and bone.

I feel really stupid about saying using the hole that was made by the bullet but could you not do that. One of the doctors please tell me i am a idiot or not. Heck anyone can let me know. LOL

Of course, without additional information, we cannot rule out narcotic induced pulmonary edema. I guess we are all in the same boat waiting for the follow up.

Take care,

chbare.

Was the drugs a important thing or not. With the hx of the bronch done with in the last month it was a flag to me. That is where I was coming from. I agree chbare that without more you can not really rule that it was anything.

I had to do a 30 min presentation on ARDS and I remember talking about drug induced ARDS.

"...even though chbare, one of the smartest people on the City, thought it was relevant."

Thank you, I have a few lucid moments here and there; however, most of it related to my mad ninja Google and E-medicine skillz.

Obviously, we have many problems to rule out with this patient. I simply answered the question asked by the OP. Narcotic induced pulmonary edema is not a common problem, and it is seen more often in herion users, so, there are many other problems that need to be considered as well.

Take care,

chbare.

I agree with you here. ARDS is what I was thinking and is typically non cardiac pulmonary edema. And the drugs most commonly that cause this are the ones that chbare said.

No one ever said anything about anyone being a dumb medic student. We was all there at one time or another. I had no idea that you just went in told the nurses and then left. I do not see why people get so offended when we ask questions. I never said anyone was dumb or anything. I was just giving different problems it could be and that was all.

It bothers me that students get offend and feel like they are being attacked. I never had that intent. I do feel like I was attacked for just asking questions.

You made it clear you didn't care about the part of the scenario she found interesting, even though chbare, one of the smartest people on the City, thought it was relevant. And then have the gnads to be offended she didn't answer your other questions?

You got the response you deserved.

Did I say that the drugs where not relevant? She said drug seeker and stated pt's hx of drug abuse. Never said why she was in the ER. that is what I was confused about. I am not trying to play who is smarter. I know that drugs can cause ARDS so I am not saying it is not the drugs was just trying to figure out why she was in ER.

You know, I'm just a dumb ol' medic student...but I'm trying to see what criteria you've used to decide this patient is in big trouble? Does it sound like she's having an issue...sure. Is it time to throw the entire hospital at her...I don't see it.

Did I ever say throw the whole hospital at her? I do not think so. I mentioned some test that needed to be done that is all. Can someone be compensate and have normal vital and skin signs but be about to crash? She had to think the pt was in trouble since she heard wet lung sounds and said she may need bipap. That tells me that she is having some type of trouble. I never said BIG trouble just plain trouble. Meaning she could go down fast or she may not. Definitely need to get on it though.

She could have bronchitis, have aspirated her jello, been gargling with salt water...We don't really know yet do we?

You are right, but I was saying the different things that could be wrong with her at the time that could be life threating. She had a bronchoscope within a month. Why did she have that?? That is a red flag for me.

Yeah, seems pretty hinky doesn't it.

Lighten up man...Ask good questions with some respect and you'll get good answers. I know...I've asked her a million of them...

Well I think I did ask good questions. If I seem disrespectful it was because we did ask and never got a answer.

Did you get lung sounds on this woman Kaisu? Is it possible you were hearing rhonchi instead of rales?

Cool case...I'd like to hear more about her presentation...We can PM if you'd prefer to avoid all of the bitching in this thread....

Dwayne

When was I bitching???I just was wondering why she did not answer anymore questions that was all.

Well I am shocked but not. I was hoping this would go somewhere. It would have been interesting. OH well. I kind expected it.

So you are not going to answer our questions or anything. Just thanks I got what I needed???

First why was she at the ER for in the first place. You never said what her C/C was. That will solve a lot of this problem of trying to figure out what may be wrong with her.

Second Who cares is she is a drug seeker? She is in trouble at the moment and needs help.

So she could be in acute pulmonary edema, pneumonia, or be having a AMI. If I remember right AMI affecting the left ventricle could cause acute pulmonary edema? If I am wrong please correct me. I am not perfect and always willing to learn.

She is in her 40's? Is she overweight? Any hx of chest pain or having this before. She said no to the bipap and c-pap fast, so has she ever had one on before or did you explain what it was to her. She is tolerating a NRB mask but not c-pap or bipap mask?

Did you go get a nurse or go see the patient and then go tell the nursing staff?

I would think she needs a stat EKG, Chest XRAY, Full set of labs.

I work 48 on 96 off and love it. I get four days off with my family. I will admit, I get tired sometimes but it works out. I work rural so there are days where I only run 2 calls in a 24 hour period. I can remember a few times only running 3 calls in 48 hours. We can lay down anytime we want. I work with a good crew so we take care of eachother.

We alternate calls during the day. If it is your first day then you run all calls after midnight unless back to back. then your second day at midnight you get to sleep and only get up when needed.

So if it is my second day and the new crew knows I been up all night they will run all calls til noon or so. that lets me and my partner sleep and rest. The crews I personally work with are great and like I said we take good care of eachother.

" i would disagree with your differentials, no pneumo, she was moving good air with clear LS. and although you never know and i cant rule it out, she didnt seem to be in enough distress to have thrown an emboli."

Why would you disagree. Those where my first two thoughts that popped into my head. What was her Spo2. You can have very clear lung sounds with a PE, and she might not have enough occulson yet to be in the severe distress yet.

Ok so what are her SPo2?

Does she have any pain in her joints or numbness anywhere?

Does she have aa hx of anxiety?

the whole point of my last post is this, There are times we have to make judgement calls to help our patients. It is not always putting a tube here or there, starting a IV or splinting. There are ways to treat a pt besides all of our "toys". Sometimes our patients just need someone to talk to, help them back up after a fall , or even get them their dinner. Yes I have been called for a fall and the pt refused to go to ER. My partner and I got the lady her dinner and water and was off to next call. Sometimes we do not understand our patients or their familys reasons for doing stuff but it takes someone that will not be bias and willing to take the time to understand them besides jumping to a conclusions, and I think that is what younger people do jump to conclusions before thinking things out.

I will have to look up in my ems book to find a list of the different development stages we go through. The reason I say this is because I think there should be age restrictions for becoming a EMT.

The reason I say this is from my own personal experience. I am 27 now and very happy that I waited to take my paramedic classes. One I was more into learning and studying. I am not saying that a 16 or 18 year old would have trouble with that either.

The life experience is a big part of our job. I am only 27 and my partner is 42. I listen to her a lot and things because she is older than me and I respect that. I mean she can keep me level headed and open my eyes to things and make me think about calls.

Look at this point, there are things that need to be done for a patient besides just skills. I mean like calling in certain services to help the patient that sometimes younger people may not know.

Here is another point. There was a thread on a elderly man that was intubated even though he had a DNR and was end stage cancer patient. One poster called them idiots for intubating him. I kind of understand where they was coming from but with no DNR does not matter.

There is a reason I brought up the intubation thing. There are times that you have to talk to a family member and understand where they are coming from. I mean sometimes younger people have trouble seeing and understanding the big picture. In the intubation thread the wife wanted him tubed so the kids could say good-bye. Is this a bad thing? Not really, I mean do you know the family situation at all? There are sometimes family dynamics that are sometimes missed due to being tunneled visioned on certain things. I think as we get older and have more life experience we start to understand things better and know what things to ask in certain instances. Maybe the kids told her they would hate her if they did not get to say good-bye, maybe they had accused her of stuff. We do not know. Maybe she would have felt guilty if she did not let them. That is stuff she would have to live with not the EMT's that where there. So we need to not only think of the pt but the family also.

I guess to me this is a good reason why I think there should be some age restrictions. I think the older we get the more sound judgement calls we can make. Not saying that younger people can not make good judgements but sometimes hard to do with little real life experience.

I thought these patients do not do well and usually die.

Great one I was going to say smell breath, until we got the blood sugar. But smell the pee!!! I'll remember that on my next ALOC call...sniff sniff

I want to be there when you go to do that. My I smell your pee I am a professional. LOL

But smell can tell us alot so I try to ask if my pts have funny smelling stool, pee , or vomit if i get a NVD type call. Well I try to remember too.

There are three amino acids this baby will have to restrict from his diet for the rest of his life. Can't remember them right now, but did google it. That was a good one Brock...See you Monday...

Awesome I am going to try to find a brisket for mon. Have fun in the morning.

Well, I don't know of any real prehospital treatment other than supportive care. The baby will need a special formula and probably won't be able to be breast fed. Maybe sodium bicarb to combat possible metabolic acidosis.

I think it is really just a special diet is all and supportive care. LOL

HOW IS IT TREATED? LOL you guys got it. I just wanted to remind people to ask about smells they can tell you alot about the patient.

Crap, what are forgetting?...Assessment tool...Cap Refill? BP? HR? Bowel Sounds? Baby is only 5 days old, can't have much history...What medical history do mom and or dad have? How closely are they related? Amish don't take many meds usually, sometimes herbal suppliments...Normal delivery...we know it's a genetic problem that makes this baby not react well to something mom is passing in her milk...(sorry, just rethinking out loud) (feel free to help me think) BROCK I LOVE YOU DEARLY, BUT YOU ARE REALLY TESTING ME!!! Dark Urine, Altered LOC, seizure, hard to wake up possibly because of previous unwitnessed seizure, a little warm, but not too high temp...I do know this is a metabolism problem or allergic to something in mom's milk and it is rare and more common in Amish community

It is smell. The baby had not been eatting alot and no one really asked about the urine to see if it decreased and what it was like. Smell is very important in this case and others. LOL With the particular thing the urine smells like maple syrup

Maple Syrup Urine Disease aka Phenylketonuria

That is it. Now how do you treat it?

now you have everything u need.

Baby not eatting right, having sz, amish family, urine that smells like burned sugar or sweet. What does this kid have and how is it treated? it is a simple treatment.

ok, back to the pee. What does it SMELL like?? PMHx: did siblings or parents have something similar when they were kids????

Brat :angel8:

It smells sweet like burned sugar.

dhowes, we're thinking the same thing at the same time!!! Brock, I have less than an hour and a half left on my shift....I will not sleep tonight! Give us another hint. You know I';ve always loved you, right?

Brat :angel8:

Ok another hint. we are not using all five senses

I know this may be too simple but is any body else in the household possibly Lactose intolerant?

Nope no one is. LOL Everyone is forgetting a great assessment tool. LOL

What has mom added to her diet since the delivery? Any Herbal supplements?

Nothing added. LOL

Hmm i will give another hint maybe but what is it to u. LOL

Is the mom passing on a protein that the baby is unable to metabolize because of a genetic disorder? Someone help me...Go to google...look up rare illness found in Amish communities...There are at least 35 of them and i can't get through them all...I have to go to work in the morning and i don't wanna think about this all night...Brock, I will see you Monday and we better have this mystery solved or you are in big trouble...LOL

you will have it figured out before then. LOL trust me. I can not wait to come to work and see you. So how many of these have you been through. There is one thing that you can ask and have it solved!!!!!!