Woman screaming in pain...

[emt322632]

It's 5am. You just got your truck all cleaned up from another run and are on your way back to the station for some much deserved sleep.

Suddenly, the tones drop for your agency...

"Respond to 1234 Main St for a 54 year old woman screaming in pain..."

You arrive on scene and are greeted at the door of a rather large, clean house by the woman's husband. He tells you she has been sick for the past 2 days, and has urinated the bed twice which is unusual to say the least. He also says she has had a decreased LOC since last evening at about 6pm.

He takes you upstairs to the bedroom, where the woman is lying on the bed....snoring. She appears to be sleeping. He says she awoke from her sleep about an hour ago, clutched her leg and screamed in pain.

What do you want to do, what do you want to know?

(This is a call I had recently, very interesting outcome, lets see if anyone gets it)

[shannon710]

attempt to awake the pt. assess her ABC's and loc at that point. get a hx of the present problem. get a set of vitals, SAMPLE and have the husband get meds together

[emt322632]

You scream her name and no response. You attempt to rouse by painful stimuli and her eyes flutter open briefly and she goes back to sleep.

Husband brings you one pill bottle, Suboxone 8mg.

Husband says that she was fine yesterday, but has been sick the past few days with nausea, vomiting, and diarrhea. Says she hasn't been able to keep anything down. He also says that she wet the bed twice tonight, which is very unusual for her.

Vitals

BP= 128/72 P = 88 regular R = 18 regular

Airway is patent, self-maintained. Good Lung sounds bilat. No obvious bleeding.

no allergies, past history of back surgery 1 month ago. no other medical problems. last ate yesterday, yogurt and nothing else.

Husband says no other meds in the house and she has taken no OTC meds. He also admits that he works alot and isn't home much....

Anything else?

[Eydawn]

Let's make sure the airway is taken care of and she's well oxygenated.

Then I might consider a couple of things. Recent history of some fairly major surgery + woman grabbing leg and screaming in pain --> unconscious/AMS... makes me suspect DVT with a clot that busted loose headed for stroke/MIville. What does a 3 lead or a 12 lead show? Pupils?

The other thing I'm wondering.. how many of those narcotics were prescribed, and has she been taking them recently? Did she take a lot initially, then not take any, and then take too many? Might consider Narcan slowly to see if you get any reaction at all, then stop short of completely waking her if you've got control of the airway.

Regardless, she's prolly gonna need an MRI to really figure out what's going on.

Any change in pt presentation? Get her in the rig and we'll continue as we move!

Wendy

CO EMT-B

[Kaisu]

makes me suspect DVT with a clot that busted loose headed for stroke/MIville.

There is no way that a DVT can cause a stroke. Any clot must pass through the lungs first, which are a big giant filter system.

[Chief1C]

There is no way that a DVT can cause a stroke. .

A DVT typically does not lead to a stroke. However, rarely this does happen in the patient who has a "hole in the heart" e.g. patent foramen ovale

http://www.fvleiden.org/ask/47.html

[ERDoc]

There is no way that a DVT can cause a stroke. Any clot must pass through the lungs first, which are a big giant filter system.

This is one of the ways that people find out they have an Atrial Septal Defect (hole in the septum seperating the atria). This clot passes through the hole and into the systemic circulation.

How long has she been on the suboxone and was she on anything else before that?

[mobey]

Check out the prescription date on the Suboxone and have my partner do a quick pill count.

Visualize the leg, and palpate.

Does the Pt. feel hot?

What is the skin turgor & color like?

Any Hx recent trauma? (fall)

Decreased LOC since last night...Why are we getting called now and not earlier? Specify decreased LOC.

Has the husband noticed any seizure activity?

[mrmeaner]

How long has she been at this dosage of Suboxone? Apparently she has some major pain issues. Does she use a daily pill dispenser so you can tell if she missed a dose or took tomorrow's dose?

Also, how's her CMS?

Never mind. Too late. :oops: What Mobey said too.

[emt322632]

Husband has absolutely no idea if she took the pills or not, though they were sitting right by the bedside.

Husband also questioned on recent trauma, says he doesn't believe she did anything to herself (fall and such)

Leg is warm, dry, no deformities, contusions abrasions or the like on it at all. + peripheral pulses x 4. Pupils are PERRL

Husband says she has just been getting increasingly lethargic since last night, and today he couldn't rouse her at all.

While you are doing your assessment she sits up and lets loose with what sounds like a scream and a yawn together, then falls back to sleep.

Pill count doesn't show any more pills missing than what should be there. She has been on this prescription for about 1 month.

As far as the husband knows, no other meds. He was working out of state for a while and just came back recently. Also says no history of seizures and no seizure activity today or last night.

You get her up, after putting 02 on her, and manage to move her downstairs. She has urinated herself again. You put her on the monitor and see a regular sinus rhythm with unifocal bigeminal PVCs.

Now what?