Pavehawk

I have to agree with Wendy, although the clinical picture paints PID (and or associated complications) you say she says she is NOT being sexually active (again is she being truthful?). She needs a work up that includes labs (and an HCG cause Im still going to R/O ectopic), a pelvic, ultasound (especially if the HCG is up), etc. Does she have an IUD in place? Does she douche frequently? History of STD? As I said earlier the differential for this is long. She may even have developed a tubo-ovarian abcess secondary to salpigitis and require surgery. Bottom line she needs a hospital and a work up. I also have to agree with 1C. Kiwi I think you have a lot of knowledge and are passionate about your job. You do come across as a bit of a "clinical bully" trying to beat people up with your impressive array of knowledge and playing "I know this you don't therefore you're a poor medic" You copped an attitude with me... "a common misconception" well that's your opinion and you can certainly voice it but your bedside manner, so to speak, sucks. I don't like condecending attitudes and I would bet most other folks here don't either. Anyway like 1C Im done playing Kiwi's "Look how smart I am" changing scenario of Gyn doom. Thanks for the scenario bud have a good day!

There is a huge differential on any woman who is old enough to have children (on the young ones too but some stuff can be safely ruled out). I don't know much about NZ prehospital care but in the USA what exactly is going on with the gal is not really a field medics job. Even an MD in the field without labs, ultrasound, X-ray, and limited in the scope of their exam, i.e. no pelvic/bimanual exam is going to go... hmmm. febrile, hypercapnic, dysuria.... could be this, or that, or whatever.... So in the USA we would transport to her hospital of choice where she would be worked up, figured out, and treated. If the doc/nurse/whatever asked what we thought was wrong the answer is going to be along the lines of what 1C gave as a hand off. Does she have an ectopic?? She denies...but patients have been known to lie, does she have a hot appy?? who knows, UTI?? who knows... thats what the hospital does NOT what the medics in the field do. Recognizing that the gal is sick and needs to be seen is the gold standard along with symptomatic treatment PRN. Once she hits the ED then the work up will point us to where we need to be. In your system you may do things differently so please rather then spank "us" for not trying to over think a patient*, tell how you guys would "pin point" her pathology in the field in the back of your ambulance. * Please don't take this as being anti-knowledge for EMS people but we have to recognize that difinitive differential diagnosis of complex medical problems is the job for the ED/Clinic etc. Having a good knowledge base is great and EMS eduction in the USA is lacking in many ways but I would rather have a medic in the field that says... "I don't know wtf is going on here, but this gal needs to go to the hospital." then one who says "Ooh damn this gal has hysterosalpigingiooophoritis and needs to see her PMD on Monday.." and be wrong! Cheer! Pave

I don't like her O2 SAT at all but frankly I think she will get better care at the other ED which is only 5 minutes more down the road and I doubt they would admit her there. I would certainly consider it IF she needed an airway but that does not seem to be the issue. She has been this way for a while, a few minutes to get her to the right place will save a critical care transport later.

I concur. Sick kids need to be in the in a pedi ED if one a in reasonable distance. In this case it would be ridiculous to go to a further away Adult ED.

Post partum hypertension is fairly common, post partum eclampsia (pre or not) is pretty rare and very nasty. Glad you had a good outcome. To be fair to the medic(s) your disease process differetial was complex... HOWEVER they certainly didn't treat your symptoms correctly or with the urgency they deserved. Field medics often get caught up in the I don't have a clue what this is so I guess it's nothing bad cause they didn't teach me about it and we dont have a protocol for it. What they should be doing is treating you for the adverse symptoms you were displaying... high fever dyspena, hypertensive and an SVT at >200 in a POST OP patient calls for ALS. On the bright side unless they were complete idiots (and they may be) they learned something that day that might save someone elses life. Thanks for the intersting case!

Yep she needs a lot more work up then she is gonna get in ambulance. The hypertension asks more questions then it answers... post partum hypertension after ecalmpsia is not unknown nor is actual post partum eclampsia. Well at least she's not having a siezure!

I would doubt that, TRALI is generally a much quicker onset < 6 hours or so, unless she was transfused withon that period and sent home for some reason.

There are no "trendy diets" that will work as well as eating a balanced healthy diet. If you have specific concerns abut your personal nutition make an appointment with an RD and if possible with one who works with athletes. They should be able to tailor a program to you based on what you need to achieve your goals. The simple rule is eat less then you burn to lose weight. As to the soreness... think what you are doing to your muscles when you lift or actually more so when you lower the weight. That eccentric movement will cause micro tears. There is really no real way to mitigate that other then to wait it out, though some like massage, yoga or low impact aerobic cooldowns. I would Invest in a personnal trainer for a few sessions to make sure you are using both the right weight and the right techniques.

Spend a little cash on Dale Dubin's EKG book, it's been a mainstay of many a medic/nurse/MD for 30 years. Easy to read, interactive in a semi-workbook way with great mirth to make things fun as well as informative.

My first thought based on history and the limited presentation is that she is in a rare, but documented, post HELLP C-section shock syndrome which is mimicing the PE (though PE is not a bad guess either along with sepsis). She should be treated aggressively for shock and watched for trending response. IV antibiotics would NOT be out of line here due to the high fever but really need some more information i.e. ABD exam, BP/FiO2/Capnography, POC lab work if available 12 lead (she seems a bit fast for sinus tach I would want to Diff dx for Afib/Aflut/AVNRT/AVRT/AT) and a CXR /CT once in the ED Bottom line... she is sick (perhaps with more then one pathology; some folks don't catch a break) and needs to be in hospital. Field care is supportaive in nature. I would certainly like to see her transported to a hospital that has GYN and Surg capabilities ASAP. How did she do?

ROFL... and there was a news feed today spome guy trying to break the record for being buried alive...doed during the attempt; Sri Lankan man dies trying to win burial-alive record

Sorry to upset your funny... but parks is part of The Department of the Interior not Ag.

A good differential Dx is essential to medicine, the patient is hypoglycemic AND acidotic, with a HX of hypertension (which is not well controlled or noncompliant) and has other problems. Hypoglycemia that does not correct well and or reoccurs after TX is obviously caused by too much insulin..."from one source or an other" and once he is lucid and can be questioned the answer may be obvious but until then the simple to the not so simple need to be factored in. Regardless of "how the hell..." the EMERGENT treatment is still going to the be the same...trying to figure out causeation is why internal medicine is so cool! cheers!! Pave

In Florida you must be 18 years old to enter EMT programs. In the mean time you could try taking first aid, CPR, lifeguard training, etc or find a fire or police explorer program to learn what you can and get a feel for public safety.

Another thought could be alcoholic ketoacidosis not a common thing but would be part of the diff dx