firedoc5 Posted June 20, 2008 Share Posted June 20, 2008 Called to a ceremony where several young girls were receiving awards. While standing in line in a very fancy dress, 17 yr. old girl passes out. On arrival the girl was conscious but seemed confused, head resting in mom's lap. She could not recall the event. Skin warm, slightly diaphoretic. Resp. 20, Pulse 60 reg., BP 110/60. Unable to put on monitor due to dress and by-standers. Have to wait until inside ambulance. Placed on 4L O2 per NC. Chief complaint of feeling weak and "woozie". No pain. No ETOH. BG 115 (If I remember right). No Hx. of medical problems. Slight built but athletic. Asked about possible pregnancy, she's starts sobbing. Go for it. I will say that it can throw you a curve ball... Link to comment Share on other sites More sharing options...
mobey Posted June 20, 2008 Share Posted June 20, 2008 Is this an outdoor event? if so what is the temp? Any drug use today? no ETOH today, but how about last night? Why the sobbing after the pregnancy question (excuse mom from the area) Do a quick focused on the abd over the dress. Any N&V Has she been sick lately. Use the mirror on the end of your boot to get a cheap peek up the dress for blood. OK we can wait till the unit. But we can ask if she feels wet....no, wait....ummm ask her if she thinks she is bleeding...Ya that's more appropriate Link to comment Share on other sites More sharing options...
firedoc5 Posted June 20, 2008 Author Share Posted June 20, 2008 Inside a fellowship hall of a private club, Elks I believe. She's about a week before her period is due. No PMS. One thing with the dress, "her cups runith over", and not quite a hoop skirt but it's big. (I'm not up on fashion). No drug use ever, nor ETOH. Taking no meds, no allergies. None of the other girls feeling hot or sick. No N/V. Just occasional queasiness a few minutes before syncopal episode. No shortness of breath. Link to comment Share on other sites More sharing options...
mobey Posted June 20, 2008 Share Posted June 20, 2008 Ok let's move to unit, I need to ask personal questions (mom can ride up front) How was the flow of her last period, (coulor, quantity etc and when exactly was it?) Is there a chance she could be pregnant? If no, why not? Do her breasts feel tender or painful? Has she put on or lost weight lately? How has her eating habits been? Recent trauma or surgeries? Physical exam: Temp Palpate abd Air entry sounds Grip and push/pull strength. How was her gait while walking to unit? Link to comment Share on other sites More sharing options...
ccmedoc Posted June 20, 2008 Share Posted June 20, 2008 did she wear a corset?? Maybe she 'caught the vapors'..... -just sayin' Link to comment Share on other sites More sharing options...
rdelisle Posted June 20, 2008 Share Posted June 20, 2008 When and what did she last eat? Is she using "diet supplements" to maintain her figure? Also a quick check of the abd would be in order to rule out injury or "corsets" Link to comment Share on other sites More sharing options...
firedoc5 Posted June 20, 2008 Author Share Posted June 20, 2008 Last period was normal. Insists no sexual activity, ever. Finally got to where I could get the monitor on her. No corset, but had a strapless "wonder bra" which she didn't need. Monitor showed NSR @72. Some pain on palpating abd. up right quad. No other abd. pain. Temp. normal. Did start to develope right sided flank pain, but "just uncomfortable". Last ate at the ceremony dinner about an hour before collapse. Had salad and a spagetti dish. Still no N/V. Seemed to be improving with O2. She did not walk to ambulance. No pain of breast, let my partner check that. She was a big help with that. Patient did state that removing her bra was a "relief", but did not feel stressed by it before. Lung sounds clear bilat. Pupils PERL. Link to comment Share on other sites More sharing options...
mobey Posted June 20, 2008 Share Posted June 20, 2008 Hmmm, could be breast CA causing the engorged breasts, causing back pain. I am kinda at a loss with this one. Temp? I'm not convinced she's no prego. Could be a rape victim not ready to talk. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 20, 2008 Author Share Posted June 20, 2008 OK, curve ball time. This threw me for a loop too. Just before transporting she said that her right sided abd. pain was crossing to her left side. Started to complain of "heart burn", but not nauseated. BP 120/100, Monitor showed sinus tach @ 100. She did say she had some pain the day before but not as severe, didn't think anything of it til just then. IV NS started. Her right flank pain also spread to her left side and up her left shoulder blade. Became diaphoretic moderately. Appeared somewhat pale under cabin lights, which is very accurate sometimes. Link to comment Share on other sites More sharing options...
VentMedic Posted June 20, 2008 Share Posted June 20, 2008 Some pain on palpating abd. up right quad. Was the palpation random or specifically for the Murphy's sign? Murphy's sign positive? Link to comment Share on other sites More sharing options...
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