hammerpcp

Well.....this was a pretty anticlimactic scenario wasnt it? Funny cuz when I was tested on it a few things through me for a loop. Would anyone shock this rhythm?

...You saw the part about her being pregnant, right?

I don't see the point of this statement.....?

anyhoo, the pt has now arrested. You still have no line. You see a narrow complex on the monitor at a rate of 180.

...You saw the part about her being pregnant, right?

I don't see the point of this statement.....?

anyhoo, the pt has now arrested. You still have no line. You see a narrow complex on the monitor at a rate of 180.

Well, I am not looking or touching. Their is no life threat. there is no treatment I can provide. I will base my priority assessment on the level of distress th pt was in and that all. As far as symptoms and signs I will ask the pt to describe for me. This is not negligence. I wouldn't know what I was looking for anyway. It is out of my realm of expertise. I wouldn't do a pelvic exam on a woman either.

What's heel strike? Is that a joke?

Alsright so, due to pt be very edematous you can not get an IV. 1 mg of glucagon administered. What about A/w control here people? 5mg Diazepam administered rectally.

Seizure stops.

Sidenote no PMS or problems with PMS.

CBG is still 2.5 mmol/L. Pt goes into seizure.

Equal grip strength. Only medical history is cholecystitis 2 years ago. No prenatal care.

Pt has had severe headache since yesterday afternoon. The abdo pain and headache both started this morning, approx two hours ago. She describes the abdo pain as constant and severe stabbing type pain in lower quadrants. There is no facial droop but pt is feeling dizzy and nauseous.

VS

BP180/94

HR 120 sinus tach

SpO2 96% on O2

CBG 2.5 mmol/L (norm range is 3.6 - 6.8 )

PEARL

skin as above

Okay Jouleman, here are some things I recommend to add a positive spin to the possible (read probable) state of burn out you find yourself in.

First, as soon as you enter the scene of a person that has called 911, the first thing you need to do even before identifying who the pt is, is to announce to the room that "we are not a cab service". No matter what the problem you are responding to, doing this immediately focuses everyones attention on you, which is always good cuz who doesn't want attention? Second if it is a bs call then you have already gotten the main issue on the table and you don't have to tip toe around it for the rest of the call.;Pretending the problem is legit. Also, if it turns out to be a legit call and someone doesn't want to give you the pts medical history or med list because they "already have it at the hospital", all you have to do is refer back to your opening statement.

I also recommend asking pt's about totally random symptoms or inventing illnesses all together. I frequently have pt's that experience pain behind their eyeballs upon urination, or have a history of choleotemporalitis, or renalosteosis. Also, drunks are amazingly good singers and often have fantastic life advice.

So, in conclusion, embrace the jadedness......have fun with it, because nothing we do out there makes any difference anyway. :shock:

Not sure if these apply to humans, but will give it a try.

General Impression?

ABC's? H?yes

Describe Pain?

Tenderness or Rigidity?

What Quadrant of the abd.?

When did pain start?

Will go from there.

Pt is in a residence sitting at the dinning room table. She is obviously pregnant. Alert and oriented but her speech is slurred. She appears to be in no respiratory distress. Her skin is warm, flushed and moist, and she has her hand on her head. Pt tests positive for humanity.

Woah there tonto! slow 'er down. I can't keep up with this e-speed-assesssment.

It's part of the primary assessment; ABCH.

Emergency call to a 29 y/o human female, c/o abdo pain. GO!

You are right Dust, as always. This job is bullsheet. I am quittting right now. Maybe one of my buddys will break a limb for me.

I assume the above poster was referring to societal tendencies of money allocation rather than a literal meaning that hospitals were spending money directly on building their arsenal. Obviously.

"He that desireth life, he must prepare for death."

By the title of this post and the subsequent poll, I thought that "turducken" was some kind of new game that must be played like dodgeball but with poop.

I have to admit I was a little disappointed that it is just a menage a poultry.

I've had a few.

The one that immediately comes to mind is when we had two shark bites in the same town, about two hours apart. That was an interesting shift

It's interesting because they are landlocked!

I had one.

http://www.silive.com/news/index.ssf/2007/...ws_of_vici.html

Awww....are you wigglesworth? That's cute. BTW who writes these articles? They are terrible.

Okay so I stopped reading responses on page three, so if I am repeating anything someone else has already said I will still take full credit. I am not sure if it has ever happened in the history of humanity that a person has experienced spontaneous bilateral pneumothoraces without some kind of previous history of lung disease. This means that this patient must have a tension pneumothorax if he is having no air entry bilaterally. This automatically will cause decreased cardiac output. You would be able to recognize this because strong radial pulses would not be present even if you did not have time to obtain a BP. BTW, we dont treat a pt with a pulse prior to at least trying to obtain a BP. Who does that? a needle thorocostomy on a pt with an unknwon history who is supposedly hemodynamically stable? Is your preceptor retarded?

typos edited. some left in for interest.

If it can vacuum I am in!

No game and all play.

I won't do it again I swear! :wink:

Agreed, but Nurses, Doctors, Medics......there is a few in every bunch.

Treat every doctor you encounter like a moody & hormonal woman......but there will still be times when you walk away scratching your head wondering what you did to deserve the comments made.

That is a really stupid and ignorant thing to say to put it mildly.

OP,

low sats are common in sz pt. Think about it. You have uncoordinated muscle contraction with tonic clonic sz. How can you expect to have coordinated respiration? BVM for any pt sz for more than two minutes. Hot pt's post sz also normal. Like you said tonic clonic activity is very labour intensive. Hence the occasional hypoglycemia after prolonged sz activity as well. Sz= huge metabolic demand. That being said I would expect the temp to return to normal after being sz free for half an hour +, as you said as well. Of course we all know that hyperthermia can induce sz even in adults. So the question is whether it is the cuase or the result. Perhaps a pneumonia? Just speculating.

The drug admin was absolutely appropriate. It is SOP. This Doc may have made the same mistake Asys did. Then he felt like an a$$ so had to administer flumazanil (sp?) to save face. Once that didnt change the pts cond't it should have been clear to everyone that of course your benzo was not the cause of any of the pts symptoms.

Dust, why didnt they just administer the guy narcan? Narcotics overdose are really no big deal as long as resps are supported.

Anyhoo, it is important to remeber that many dr's are the guys that couldnt get into vet school...and that even the guy at the bottom of his class is still a dr.

It is clear to me that the OP's main problem is the brain damage.

nerd.

Looking at Hammers recap, I have a few questions:

1. Does this kid has some unknown metabolic disorder? A 60 pound 12 year old, things that make you go hmmmmmm.

2. What meds was he taking and who was giving them to him?

3. Is anyone else at home or at school sick?

Hammer, why can't this be meningitis? A kid with fever, possible sepsis and mental status changes could definitely have meningitis.

Agreed, I initially was also thinking that as part of the differential. The Pt has no nuchal rigidity, and a negative LP. In scenario world that's a rule out I think. Also there was no complaints of headache, and a hx of three days of GI symptoms followed by neuro probs is a little slow onset.....at least for bacterial meningitis.