firedoc5 Posted June 13, 2008 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. DARN Link to comment Share on other sites More sharing options...
AZCEP Posted June 13, 2008 Share Posted June 13, 2008 CBC, and a chem panel Do the lung sounds change after intubation? How about vascular access? I'm also considering using an N95 mask. :wink: Link to comment Share on other sites More sharing options...
Eydawn Posted June 13, 2008 Share Posted June 13, 2008 What are those cloudy regions? Is that tissue degeneration from an infectious process, or tumor? Sputum culture time... Waitaminute... could this be tuberculosis?! Tuberculosis meningitis? Would that explain the cloudy regions in the chest x-ray and the seizures... http://professionals.epilepsy.com/page/mycobac_tbm.html But how would his history of being a smoker factor in to that diagnosis? And if we suspect it, shouldn't the whole family be screened for TB infection? Am I off in left field? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
Adam Swartz Posted June 13, 2008 Share Posted June 13, 2008 For labs get a full ED panel. Link to comment Share on other sites More sharing options...
WelshMedic Posted June 13, 2008 Share Posted June 13, 2008 I think he may have metastases in the brain causing the seizures, but then again I've had the benefit of reading all the previous posts..... WM Link to comment Share on other sites More sharing options...
firedoc5 Posted June 13, 2008 Share Posted June 13, 2008 What are those cloudy regions? Is that tissue degeneration from an infectious process, or tumor? Sputum culture time... Waitaminute... could this be tuberculosis?! Tuberculosis meningitis? Would that explain the cloudy regions in the chest x-ray and the seizures... http://professionals.epilepsy.com/page/mycobac_tbm.html But how would his history of being a smoker factor in to that diagnosis? And if we suspect it, shouldn't the whole family be screened for TB infection? Am I off in left field? Wendy CO EMT-B Stupid me, I only glanced at the x-ray. TB, pneumonia, CHF, Emphysema? How are the extremities over all, edema, especially hands and feet? If entubated, was there any edema of the epiglottis, epiglottitis? (Lost a 35yr. old due to that) If over all edema consider Lasix, foley cath. Attempt any kind of breathing tx., doc's choice. I know, I'm still reaching. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Good thinking, the history would be suspicious for TB. Does looking at the chest X-ray help? We have what looks to be a narrowed mediastinum (Hard to tell with the size of the pic), hyperinflated lung fields, and a diaphgram that is pushed down. All indications of something that can cause a hyperinflated chest. (COPD, Asthma, etc) So, this is consistent with his chronic smoking and barrel chest. I am not sure that we can tell anything else from the file? Obviously, this would be a pre-intubation film. I think the SMA-12 and CBC are great tests to consider in this case. We can look for infection, electrolyte imbalance, and multiple other problems with these two labs. Significant findings include: NA+: 102 mEq/L , BUN: 5 mg/dl, and You calculate serum osmolality at 208 mOsm/kg. Sputum culture is negative for acid fast bacteria. Non contrast CT of the head: narrowing of the ventricles noted. No other significant findings are noted. (No large masses, mass effect, or midline shift.) Take care, chbare. Link to comment Share on other sites More sharing options...
Eydawn Posted June 13, 2008 Share Posted June 13, 2008 I don't know enough about lab values to know what the results mean. Here is where my education is as of yet severely lacking... So negative for acid fast bacteria = no TB... Narrowing of the ventricles... swelling? Is it viral meningitis? How would we figure that out? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
firedoc5 Posted June 13, 2008 Share Posted June 13, 2008 I don't know enough about lab values to know what the results mean. Here is where my education is as of yet severely lacking... So negative for acid fast bacteria = no TB... Narrowing of the ventricles... swelling? Is it viral meningitis? How would we figure that out? Wendy CO EMT-B Spinal tap (not the band). I went through aseptic viral meningitis about eight yrs. ago. But I had no seizure. Spinal taps and "blood patches" suck big time. Link to comment Share on other sites More sharing options...
chbare Posted June 13, 2008 Author Share Posted June 13, 2008 Yeah, narrowing of the ventricles is a sign of cerebral edema on the CT. Meningitis may be a consideration; however, look at the labs again. You may note some very significant findings. Take care, chbare. Link to comment Share on other sites More sharing options...
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