Dustdevil Posted December 17, 2007 Share Posted December 17, 2007 Wait, I think I saw this on an episode of Seinfeld once. Does he have a golf ball stuck in his blowhole? Link to comment Share on other sites More sharing options...
zzyzx Posted December 17, 2007 Share Posted December 17, 2007 Coming late to the game...and I'm stumped. Since he has no history of lung diseases or any other medical history, and since he doesn't seem to have any problem with ventilation, my best guess is that he's having a PE. Obviously that would be very unlikely for a healthy 16 y/o, even with his recent history of minor surgery. And I would expect to see other signs/symptoms. Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Wait, I think I saw this on an episode of Seinfeld once. Does he have a golf ball stuck in his blowhole? We have a winner!!! Seriously, someone has got it. The kid has no trouble swallowing. His EKG looks fine. Someone wanted to draw some blood, so this was done. You note that his blood looks brown in color. His lung sounds are still clear. He does not feel like there is any swelling in his airway. You are able to reach Dr. Johnson who tells you that it was a pretty simple needle aspiration of a peritonsilar abscess. He used Hurricane (benzocaine) spray for anesthesia and did not start the kid on antibiotics. He starts to tell you what the problem is but the battery in his cell phone goes dead and he is too busy cruising down the A1A in his Porche to stop and find a pay phone (if they even exist anymore). Link to comment Share on other sites More sharing options...
zzyzx Posted December 17, 2007 Share Posted December 17, 2007 ER Doc wrote, "You note that his blood looks brown in color." Sounds like Vent Medic got it with his idea about methemoglobinemia. Link to comment Share on other sites More sharing options...
VentMedic Posted December 17, 2007 Share Posted December 17, 2007 At the hospital I'd check his methemoglobin but I would expect a higher SpO2 with the additional binding. Methemoglobin is another one that skews the pulse ox readings and there are many things that can also contribute to it. The level present can be 5% or 50% and the SpO2 may remain in the 80s. I believe 85% is the magical number as stated somewhere here in this thread. A cooximetry measurement will be the most accurate direct measure of MetHb. Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Yes this kid is suffering from methemoglobinemia. For five points, someone discuss the pathophysiology of methemoglobinemia. For 5 more points, discuss why this kid has it. For 50 points (because you probably won't have it in your ambulance) discuss the treatment. Link to comment Share on other sites More sharing options...
p3medic Posted December 18, 2007 Share Posted December 18, 2007 I know it has to do with the ferric state of hemoglobin, as opposed to ferrous, and the treatment is methlene blue, which I don't carry....also HBO can be used, and again, I dont have it....great case! Link to comment Share on other sites More sharing options...
Timmy Posted December 18, 2007 Share Posted December 18, 2007 In EMS you really couldn’t diagnose something like that could you? A cause: Exposure to stuff like nitrates/local anesthetics can speed up the rate of formation of methemoglobin, this might overwhelm protective enzymes and increase something? You through me off the track when I asked about allergic or any sort of reactions to meds and you didn’t say!!! Link to comment Share on other sites More sharing options...
VentMedic Posted December 18, 2007 Share Posted December 18, 2007 (because you probably won't have it in your ambulance) discuss the treatment. Actually, it may be in the ambulance more frequently now and it may involve members of a CC team if they are transporting patients on Nitric Oxide for any length of time. We have done our own studies for our own safety P&Ps. Usually NICU transport may only run approx 20 PPM but adults may run at 50 PPM. A small area with poor ventilation flow can make the difference. Short transports are rarely a problem though. Our nurses also know better, now, than to sit close to the bedside when we are running a pt at more than 20 PPM for any extended of time especially if it is an open port system such as the oscillator vent (HFOV). We also find high MetHb levels appearing in patients that are on the nitrates for extended periods of time. They may seldom get mentioned to an ER Doc unless he/she has put the request in for the co-ox values even though the values may appear to the lab technician or RRT running the blood sample. If it is for shortness of breath, the RT will usually mention it and get an order to release the information. It is a great topic to research especially for those pulse ox dependent assessment people. Link to comment Share on other sites More sharing options...
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