ibemt31 Posted April 4, 2008 Share Posted April 4, 2008 I am presenting you with a call which i had, on which the pt, who was intoxicated, appeared to be more than intoxicated, and i was wondering what everyone one here thinks was going on. we are dispatched to a local strip club for a "man down". the bartender meets us outside and tells us he has a man that has came in for a few drinks, but that the man did not seem right coming in, was limping, and just did not seem ok, which is why he called. inside we find a dark and noisy strip joint, not a good place for a thorough assessment. the man is standing, AAOx3, and had no real complaint, stating that he was fine. I decided to continue my assessment in the bus. place the pt in stair chair, remove to ambulance. upon further questioning and assessment, the pt is c/o pain to r. leg, and some minor edema to l. ankle area. pt states he has been in the bar having some drinks. pt is warm dry and pink, lungs clear bilaterally,no visible trauma. pupils PERL. Pt now states HX of diabetes, and quadruple bypass(less than one year ago). pt states he is on a bunch of meds which are home and does not know what meds. pt appears agitated throughout but for the most part is cooperative. upon assessment of V/S RR18 non labored, pulse 100 strong and regular, and B/p of 200/118. due to HTN and cardiac HX, i decided to admin some Oxygen, via NRB. enroute to the hospital, after some 02 pt v/s reassessed, rr 18, pulse 96, bp 150/100. pt care transferred to ed staff. he was placed on a monitor, and v/s in the ED were rr 20 pulse of 120 and b/p of 90/70. at no point did the pt c/o any chest pain or sob or anything else that wasnt mentioned. however, pt did get upset when he found a picture of a deceased relative in his wallet as we were arriving at ED, i do not think this has a bearing on anything, just providing the most complete picture of the call i can. the change in b/p is very interesting. now that think of it, an additional piece of information. my b/ps were all taken on the left arm while the hospital`s b/p was on the right arm (dissection? i doubt it but who knows?) just a peculiar case that i would like to see what other people can hypothesize on. thank you. Link to comment Share on other sites More sharing options...
ccmedoc Posted April 4, 2008 Share Posted April 4, 2008 I am presenting you with a call which i had, on which the pt, who was intoxicated, appeared to be more than intoxicated, and i was wondering what everyone one here thinks was going on. we are dispatched to a local strip club for a "man down". the bartender meets us outside and tells us he has a man that has came in for a few drinks, but that the man did not seem right coming in, was limping, and just did not seem ok, which is why he called. inside we find a dark and noisy strip joint, not a good place for a thorough assessment. the man is standing, AAOx3, and had no real complaint, stating that he was fine. I decided to continue my assessment in the bus. place the pt in stair chair, remove to ambulance. upon further questioning and assessment, the pt is c/o pain to r. leg, and some minor edema to l. ankle area. pt states he has been in the bar having some drinks. pt is warm dry and pink, lungs clear bilaterally,no visible trauma. pupils PERL. Pt now states HX of diabetes, and quadruple bypass(less than one year ago). pt states he is on a bunch of meds which are home and does not know what meds. pt appears agitated throughout but for the most part is cooperative. upon assessment of V/S RR18 non labored, pulse 100 strong and regular, and B/p of 200/118. due to HTN and cardiac HX, i decided to admin some Oxygen, via NRB. enroute to the hospital, after some 02 pt v/s reassessed, rr 18, pulse 96, bp 150/100. pt care transferred to ed staff. he was placed on a monitor, and v/s in the ED were rr 20 pulse of 120 and b/p of 90/70. at no point did the pt c/o any chest pain or sob or anything else that wasnt mentioned. however, pt did get upset when he found a picture of a deceased relative in his wallet as we were arriving at ED, i do not think this has a bearing on anything, just providing the most complete picture of the call i can. the change in b/p is very interesting. now that think of it, an additional piece of information. my b/ps were all taken on the left arm while the hospital`s b/p was on the right arm (dissection? i doubt it but who knows?) just a peculiar case that i would like to see what other people can hypothesize on. thank you. There, that is a bit easier on the eyes...I will not correct your grammar though. If you want these answered...you would be better served by putting your posts in a more legible format.. That is all... on that I'm curious as to why the non-rebreather...simply because of history? Did you take his pressures through clothing? (edited for content..CC) Link to comment Share on other sites More sharing options...
emt322632 Posted April 4, 2008 Share Posted April 4, 2008 Did you compare his left ankle to his right ankle? Any bruising? Warmth? Perhaps this patient is just non-compliant with his meds, that would explain the increased b/p. Did you inquire as to the death of the loved one? As in was it recent? This may explain a few things. Perhaps he is still grieving, may be depressed, could explain non-compliance issues and the alcohol use. This leads to a question of does he normally drink? If so how much? What did he drink? Any illicit drugs on board? Any OTC drugs? If ALS on board this truck, O2 IV and 12 lead EKG. Pt. seems relatively stable despite the elevated BP. Link to comment Share on other sites More sharing options...
rat115 Posted April 4, 2008 Share Posted April 4, 2008 Was the edema in his legs normal? Was it even? Had he had some injury to his leg recently? Were his legs hot to the touch anywhere? Did he have any complaints besides being pulled out of the strip club and away from his drink? Why did you put him in a stair chair? To me, that says that he could not walk or could not walk correctly. Was the discomfort in his leg that bad? I'd be wondering about a blood clot if so. Not c/o chest pain is NOT indicative of not having an MI in a diabetic. One of the long term effects of the disease is neural problems which cause a decrease in feeling pain sensations. Link to comment Share on other sites More sharing options...
spenac Posted April 4, 2008 Share Posted April 4, 2008 What was his blood glucose level? Link to comment Share on other sites More sharing options...
ibemt31 Posted April 4, 2008 Author Share Posted April 4, 2008 Exactly, rat, atypical presentation of cardiac issues in diabetics, and htn, apparently new onset as pt was shocked that his b/p was that high is why i went with the nrb, whoever was asking about that. as for a BGL, ask the wonderful state of New Jersey why i cannot take one....my apologies for the grammar guys, 4am does not produce my best writing. as for the stair chair, inside the dark and noisy bar it was hard to ascertain exactly what was going on, and i`d rather stairchair someone who maybe could have walked than walk someone who probably shouldnt have. the edema in his leg was probably due to poor self care of his diabetes, perhaps he fell earlier as etoh abuse seems to be a chronic problem. no areas were hot to the touch, no bruising and as far as complaints, see what i wrote previously, its all in there. no illicit drug use, and the death in the family was recent which did not help issues but i think it only made matters worse if anything, it was not a primary cause of the event. Oh, and no, his b/p was not taken through his clothing.......comon, thats insulting...... Link to comment Share on other sites More sharing options...
akroeze Posted April 4, 2008 Share Posted April 4, 2008 .......comon, thats insulting...... No it's not, it was a totally fair question to ask. Link to comment Share on other sites More sharing options...
mobey Posted April 4, 2008 Share Posted April 4, 2008 This could be so many things, without a full assesment there is no way to give you any answers. as for the HTN at the time of the call, he may be non-compliant with meds. As for the agitation, it could be from < BGL, could be from anxiety, who knows. There is no way for you or us to guess what was going on. What about high bp makes you go with a NRB? Not saying it is wrong... just trying to follow your train of thought Link to comment Share on other sites More sharing options...
ibemt31 Posted April 4, 2008 Author Share Posted April 4, 2008 well for one thing, elevated bp=more strain on heart, heart working harder= greater demand for oxygen, why not supplement that and help a little. not to mention the mantra that is driven into everyone in basic class, never withold o2 from someone who may need it. Link to comment Share on other sites More sharing options...
ccmedoc Posted April 4, 2008 Share Posted April 4, 2008 well for one thing, elevated bp=more strain on heart, heart working harder= greater demand for oxygen, why not supplement that and help a little. not to mention the mantra that is driven into everyone in basic class, never withold o2 from someone who may need it. This may be a good read about the possibility of too much oxygen...or not.. :? http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#114621 Link to comment Share on other sites More sharing options...
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