EMS-Cat

The only thing I remember is he had a business card with the letter "R" on it. I don't know if I ever heard a first name. As for Columbo, it was 'Lt. Frank Columbo'. Wiki shows a copy of his ID badge. 'Columbo' :wink:

Maybe I've been around the block too many times [too many years of doing too many things in too many places], but so long as this guy is happy with his life, isn't running around shoving his personal philosophy on other people and isn't on the feds 'Doesn't play well with minors' list, whatever wrinkles his prune is fine with me. Odd... but fine. But then, that's just me. I also do med support at local Ren Faires, Sci-Fi cons and such so he isn't really the most 'out there' fella I've even met.

I've worked places where the RTs did the emergency intubations right alongside the Docs and were the ones responsible for the ECGs inhouse. Each place is different...

I put 'r/o mumps' as my first up, but I did warn folks I tend to be a zebra herder.

Hey! Don't yell at me. I'm still waiting on the STAT ER labs requested around 0630 this morning.

Sorry ... missed the contrast CT mentioned earlier. Could we have the lab results, please?

Don't know if this has already come up - my web reader is on the fritz Did he, by change, take any ' nitrates [Viagra like meds]? Could he be in that 1% or so that gets testicular pain with them as a side effect? Has he had any shift in color vision [blue shift]? Also, in consultation with my SO [who's also of a medical background], he asked for an abd US to r/o a dissecting AAA [he did a lot of his EMS in a farming area and said this was one of their zebras: young, healthy male doing a lot of heavy lifting who developed slow onset bilat testicular pain] Like I said, zebras, but things come to mind...

Old home test for parotiditis that I've also seen done in the ER, so it's not just an 'old wives tale' - it's just an old trick. Offer the subject something very acidic to taste, like a dill pickle, lemon, lemon drop, etc. If they become *really* unhappy about it [it hurts], they have something going on with the parotid gland: obstruction,. inflammation, etc. because the gland is trying to do it's job and there's something interfering with it. Sometimes just letting the patient smell the object triggers the salavary response. Or just suggesting they bite it. Try it on yorself. Think clearly about how it would feel to bite into a big, tangy dill pickle. Bets are, your mouth starts to water. Like I said - old trick, but it still works.

A couple of other things now come to mind. 1: Does he have any children or is living in a house with children? 2: If so, have any of them been sick in the last couple of weeks? 3: Does he flunk the 'pickle test'? {Honest, I'm not totally fixated on mumps. Any of the other childhood virals might be involved}. 4: Does he have a hot PPD, chest film or anything that might suggest TB [night sweats, red streaked productive cough, etc]? This comes to mind for me as we have a high PPD positive community where I am and I have friends in Idaho with Public Health who are *really* concerned about the increasing number of hot PPDs. So... any more info? Vitals, please?

So... just exactly how had he ticked off his wife / sister / significant other / buddies / etc? And has he had any intoxicants today? Sorry if that sounds trite, but it sounds like, based on what little we've heard, that I'd have to wonder if someone let him have it in a bar fight or a DV call or something. At least, that's one of the things that would be running through my head if that's all I got from dispatch. Well, along with things like kicked by a farm anaimal, fell off the top of a fence and straddeled the railing on the way down, bounced off the tractor seat and hit the tow bar. But I won't r/o testicular torsion, testicular rupture, acute epididymitis and things of that nature. Or he could be a *really* late starter and just now caught mumps. There's a lot of things to run through here. More info, please? Also, BTW, etc: If he's been trying to tx this himself, how long has he sitting on the ice pack [i don't know why, but something makes me wonder if he might have sorta froze his 'nads a bit] Just a thought.

Congratulations to *all* test survivors.

This is one of those situations where *very* good history taking saves everyone time and frustration. It certainly gives the ER a 'heads up'.

Actually, ERDoc, the 'Simpsons' comment was an after thought. Think of it as a 'teaching aid'. Seattle has at least one restaraunt that sells fugu so it's totally unheard of up here. But it's certainly a 'zebra' none-the-less. Please keep these 'teaching cases' coming. I tend to forget to stop by forum, but when I do, I always check out this thread first. Good stuff is always turning up.

Great 'teaching case', ERDoc. Thanks.

BINGO! Fugu / Puffer Fish it is! From a BLS level, this is still a dispatch ALS ASAP to the scene & support ABC's call. Also, if ALS is a ways out, be prepared to transport himself yourself if local protocols allow [there are places around here were ALS can be delayed up to 20 min. or so, but the nearest ER is 10 Min. away]. Also consider LifeFlight if needed. I'd package him and get him out to the rig so I've got a stable working area and if ALS is delayed, I'm one step up [And there's no need to have him fold up in the shop if you can safely move him]. Get ready to BVM the guy and manage his airway. And *VERY* large doses of emotional support. If it is fugu poisoning, he's going to feel like he's been hit with sux/Pavuloned/insert paralytic of choice and he'll still be totally aware of everything and every word going on around him. But, as always, follow the protocols dictated in your area, not mine. And it's time for the restaurant to find a new chef...