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Curiosity

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Posts posted by Curiosity

  1. 250ml fluid challenge see if there's any change.

    One post you said hr of 280, an other 180, and you keep switching between a him and a her, is it a transsexual who's having an anxiety attack because there are strangers around? :P

  2. No hx of SVT?

    Has this ever happened before? If so, how was it relieved?

    10/10 pain where, describe pain, did pain start suddenly, did it start at the same time he started feeling his anxiety?

    Do his anxiety attacks usually present this way, how does he relieve them when they occure?

    Any drug use, alcohol? What were they doing when it started? Any signs if dehydration?

    If no to drugs or physical activity or dehydration: O2 if indicated (what are his sats?), vagal, adenosine 6mg, 12mg.

  3. The hypothermic patients I come into contact with usually have an obvious reason for it. They're outside, poorly dressed, fell in cold water...I never would have thought hypothermia in someone who's been in a hot house for days. I've learned a valuable lesson from this call.

    Sometimes it's what's not there that gives you the answer. Ie: not feeling warm to the touch, not able to get a reading on the thermometer.

    • Like 1
  4. We have the same thermometers as the hospital.

    When we got there, we tried theirs and got the same error as in the truck.

    They found him a room and took a rectal temp. It was 32 C / 89 F.

    He was quite hypothermic, but not for any of the reasons mentioned above. There's an other scenario posted here where hypothermia was a side effect of a condition a patient suffered. That's what reminded me of this call. The next day, we were told he was in the ICU. His temperature went up only a few degrees despite attempts at aggressive rewarming.

    I was shocked to find out how hypothermic he was. I got a load of crap from the nurse asking if I had even bothered to touch my patient. I touched her arm and she yelpped, my hands were just as cold as he was. Looking back, I should have realized that anyone sitting inside a hot house for two days should have felt HOT to me, not the same as my hands were. Then there was the artifact looking ECG. He was shivering internally which was causing these bouts of "artifact". He was not shivering physically at this point. The sat monitor taking so long to work, the thermometer not working, the finger stick (i used the word stick for you Dwayne) that I had difficulty getting anything out of... Because he didn't feel cold to me, I wrote off the rest to equipment malfunction.

    There was also a big concern about the lithium. That's what I was leaning towards for this call.

    Sometimes, machines don't lie.

    • Like 1
  5. What is his core temp ???

    You grab you tympanic thermometer, put the plastic cap on and take his temperature. The thermometer gives you an error, says the cap isn't on. You try again, get the same error, try one more time, same error. So you can not get a temp at this time!

    Please don't say 'prick'...

    I'm leaning toward a heater malfunction and CO poisoning. Any symptoms in the friends that have been caring for him? Probably pretty early at this point...

    His friends have been there all evening, they are not showing any symptoms of CO.

    You've mentioned a missing vital sign, do you mean skin color? Or temp maybe? If not, then I don't know.

    Skin color is pale, almost white. When you touch him he is neither hot nor cold. As above, thermometer gives three back to back errors.

    We've left the scene with a transport time of 7 mins.

    Was he hypothermic?

    Well, I can't get a temperature on him. His skin doesn't feel abnormal. If he is hypothermic, how would that be possible? He states he hasn't been outside in days, his friends collaborate his story and the house is nice and tostey.

  6. You and your partner stand him up. He's unable to stand on his own, states his legs are really week. It takes the two of you just to hold him upright. Because of this, orthostatic pressure is difficult to do. (I didn't do one of those, but had I, it wouldn't have given you anything.)

    Last BM in the AM, patient states he did no notice any blood. No N/V.

    Captain, you load him up and attempt an IV. You find access after much difficulty and get very little flash from it.

    Any other vitals while in rout?

    I think that every ambulance should have one of these...

    http://www.cliawaived.com/cf.inventory.htm?action=showinvone&invid=1942

    Then again, I also think that every ambulance should have one of these too...

    http://www.jbodenmann.com/american/cowcatcher.jpg

    I love the Hgb meter but I'll be honest, until I starting on these forums, I couldn't tell you what the proper readings were. There isn't a big importance placed on that in my course

  7. I don't have hemoglobin level, we're still in his house. He's alert, oriented, answers questions properly although a little slowly. I'm sorry, I didn't mention age...he's in his early 60ies. Neuro exam is clear, weakness is noted bilaterally in his arms and legs but grip strength is equal.

    His O2 sats are 100% on room air, Had to try different fingers with the sat monitor before we got a reading.

    MAP 73.

    He states he's been taking his meds as prescribed and the count on the bottle doesn't suggest he's taken more.

    Did I miss any other vitals?

    Edit to include extra info about sat

  8. He admits to being very depressed. Denies any suicidal thoughts. He also says he hasn't been able to walk without holding on to things as he's very weak. He admits to this being unusual for him, he is normally pretty healthy.

    He looks sick. He's almost white in color, when you assist him in standing, he leans heavily on you and your partner, his gait is very unsteady.

    He is willing to come with us to the hospital.

    Is there any other vital you'd like to check?

  9. LIthium - NASTY NASTY overdose. I'd focus in on that pill bottle first. HOw many are in the bottle?

    Alright. When asked, the patient says he has been taking his meds as prescribed. Examining his prescriptions, that appears to fit with his story.

    The lithium was prescribed three months earlier for his mother. There are several pills left in the bottle, (I don't remember what the total number was, but there are some missing). When asked about it, the patient states that they are his mothers, he has never taken them, and they're there because he hasn't been able to throw them away yet. When asked again, he sticks with the story that he has not touched the lithium.

    I'm going to add something, because it was so apparent on scene and can't be conveyed over text. The patients affect is still flat. He shows absolutely no emotion.

  10. But continue on. I'm in a scene safety sort of mood today.

    Friends are calm. They are standing in the corner of the room out of your way. There's nothing out of the ordinary around. Nothing that can endanger you or your partner that you can see. Only thing that stands out are the bottles of meds on the table and how hot it is in the house. (middle of winter, you have your big coats on :P)

  11. What are the meds? What are the vitals? What is the gentleman's medical history? Cardiac rhythm? and blood glucose?

    Patient is pale, skin dry, patient does not feel warm. Mucous membranes appear moist and pale.

    HR: 58, strong, regular, 3 lead shows sinus brad, no st changes, p and t waves upright. Every now and then there appears to be some artifact, as though the leads are loose. 12 lead is the same.

    BP: 112/64

    RR: 12, lungs are clear, no distress noted, patient does not complain of any difficulty breathing.

    Blood glucose comes back within normal limits but it was difficult getting blood from the finger prick.

    Pupils are equal and reactive

    Last oral intake at lunch, no nausea/vomitting/diarrhea

    Hx: hypertension, high cholesterol, depression

    Rx: atenolol, atorvastatin, citalopram. There is a bottle of lithium prescribed to his mother amongst his meds.

    No known allergies

    Make sure you are between the door and the patient. Don't let the patient get between the door and you. Plus what are the other men there for?

    They identify themselves as his friends. They visit him every few days to check up on him and help him around the house. They are the ones who called because they are worried his condition is getting worse.

  12. I'll try my hand at a scenario. I'm a little nervous doing this but I am curious to see if others might notice what I had missed.

    I must mention it was a very cold evening, let's say -30 C (-22 F).

    Call came in aprox 1900, low priority for a emotionally distressed patient. Arrive on scene in a decent neighborhood and are greeted at the door by a gentleman in his 60ies. He whispers to us that his friend has been really down and he came to check up on him today and finds that he is worse than normal. He states that his friend has no energy, is always tired, and has no motivation to do anything. He will not leave the house, his friends have been helping him out because of this. He is worried about what he might do.

    Initial contact: a man in his 60ies is seated on the couch. He is wearing a white tank top and a pair of slacks. He does track you as you walk in. You notice four bottles of medication on the coffee table in front of him, the house is well kept and nothing else out of the ordinary stands out. There are two other men standing in the living room who identify themselves as his friends.

    Patient states his mother, whom he lived with, passed away several weeks ago and he was having a hard time dealing with her passing. He says over the last few days, he's been more tired than normal, complains of weakness, says he has difficulty walking. He says all of this with a flat affect.

  13. I don't know if it's the same in every program, but where I went to school, there was a portion of our time dedicated to lifts. We had to pass stair chair and backboard lifts in order to pass a semester. Weights got heavier every semester.

    Not capable of lifting, you didn't get a diploma. So all the students that come out of the schools here are physically capable of doing the job.

  14. No doubt this girl in my class was special. That's just the tip of the iceberg of stories from this one.

    And I'm not saying not to try either. But before you invest money and time, do some homework. Her disability may or may not hold her back. She's afraid it will. Go out and test your limits before you start. She may find out she has nothing to worry about and can go in with a clear head without worrying about any limitations.

  15. A few inches bellow the knee on the tibia. Feel it, there's a flat surface slightly medial. That's my access point, and the only site we are allowed to access in my service.

    If our patients have bilateral femur fx, then we're screwed.

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