AZCEP Posted June 13, 2008 Share Posted June 13, 2008 Any nicotine patches on the patient? He needs intubated as well. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted June 13, 2008 Share Posted June 13, 2008 I'll have to go with DIC. It's the answer to 1 out of 3 on House. Just kidding. Can I get a CT, MRI, chest x-rays, lung biopsy, access to his medical records, CBC, cardiac enzymes labs, capnography, cardiac sounds? Or at least some of those? Would a 15-lead and opposite side EKG provide any info? (I'm reaching now) Can I get family history? Signs of DVT? I'll have to go with DIC. It's the answer to 1 out of 3 on House. (just kidding) Link to comment Share on other sites More sharing options...
ERDoc Posted June 13, 2008 Share Posted June 13, 2008 I'll have to go with DIC. It's the answer to 1 out of 3 on House. Just kidding. Can I get a CT, MRI, chest x-rays, lung biopsy, access to his medical records, CBC, cardiac enzymes labs, capnography, cardiac sounds? Or at least some of those? Would a 15-lead and opposite side EKG provide any info? (I'm reaching now) Can I get family history? Signs of DVT? I'll have to go with DIC. It's the answer to 1 out of 3 on House. (just kidding) OK Anthony, justify a CT AND MRI. Your department head wants to know what you expect to gain by ordering both? What part of the body do you want image? Why are you getting lung biopsies? Which part of the lung are you getting a biopsy from? It's a pretty invasive procedure and shouldn't be taken lightly. PS-I'm not trying to bust your chops. I think it's great that you went out on a limb and gave your answer. Just trying to induce some more thought. Keep up the good work. Link to comment Share on other sites More sharing options...
Eydawn Posted June 13, 2008 Share Posted June 13, 2008 Well, doc, if the guy has any kind of throat/lung cancer (longtime smoker) and it's spread, we'd use the CT scan and MRI to rule out tumors contributing to the confusion and seizure... as well as doing a full body scan to look for something we might not be able to see on the surface, like tumors elsewhere, evidence of clots... If we X-ray his lungs, we can look for damage/tumors there... little parts to help us figure out the whole. I also want to know if he's got nicotine patches on... keep too many on and smoke, and I've heard you can get some wicked side effects. Wendy CO EMT-B Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Ok, I like the thinking. Go big or go home as somebody we all know says. Enroute to the hospital he has yet another seizure (tonic clonic), and you decide to intubate as AZCEP suggested. You are able to intubate without difficulty and confirm placement with the usual methods. No nicotine patches. This guy liked to smoke and had/has no intention of quitting per the family. On to diagnostics: At this point, I think you could easily justify a non contrast CT of the head. We have seizures, altered mental status, and a couple of other neurological signs. So, yeah I could give you that one. MRI's,a lung biopsy, and the such may help us out; however, this guy most likely has an acute condition that we need to identify now. A chest X-ray could easily be justified in this case as well. Are there any basic lab tests that you want while X ray warms up the scanner for his head CT? You guys are on the right track, and I think we may start connecting some dots with a little more information. Take care, chbare. Link to comment Share on other sites More sharing options...
Eydawn Posted June 13, 2008 Share Posted June 13, 2008 Can we look at arterial blood gases? Might give us some info on this guy's saturation levels, pH, etc... :oops: I fess up, I have no idea what labs to order... :oops: Someone else's turn! Wendy CO EMT-B Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Chest X ray: Take care, chbare. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 I think an ABG is a good idea. PH- 7.34, PCO2-48, PO2-84, HCO3-28. As far as labs: think about labs that tell us about the day to day functions of the body. We want a snap shot of how well the body is doing overall. What are some basic tests that give us a fairly broad view of the electrolyte status and the status of our blood and immune system? Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 13, 2008 Share Posted June 13, 2008 Nicotine poisoning. Check liver and kidney function. Heavy smoker and for some reason the nicotine taken in is not being processed and staying in the blood system until toxicity occurs over time. Any chance he could have even chewed on a used cigarette butt(s) for some odd reason? But I could be wrong. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Good thinking. Nicotine toxicity is not the problem with this patient; however, his smoking may have helped cause the problem/s. Take care, chbare. Link to comment Share on other sites More sharing options...
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