firedoc5 Posted August 17, 2008 Share Posted August 17, 2008 If it wasn't for the blood and "hamburger" appearance I might have guessed epiglottitis. I would consider the esophageal varices also. Any emesis around on the ground, especially bloody emesis? I wonder if esophageal varices with vomiting could cause the esophagus to prolapse into the throat. I don't think so, but it's something I just thought of. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted August 17, 2008 Share Posted August 17, 2008 could the "hamburger" be his chew? I ask if his "chew" is chewing tobacco? Also known as a "chaw"? While available here in NYC, I know of nobody who actually uses this stuff. Oh, I echo the question on this possibly being a chew/chaw/chewing tobacco airway obstruction, in addition to whatever is causing the nipple line and up discoloration? Link to comment Share on other sites More sharing options...
Anthony Mayernik Posted August 18, 2008 Share Posted August 18, 2008 Query: would the "something" that was mentioned to you happen to be the keys in the ignition, more specifically, in the "run" position? My unscientific wild guess is that he spit onto something energized (like, say, the alternator) and took a bolt of electricity to the back of the throat, but that doesn't make a whole lot of sense without some electrical burns around the mouth...and that's just too...CSI-y to make any real sense...please tell me I'm wrong, because that's just too "weird" to be true... The wrench being a few feet away implies it was thrown as a result of the trauma, so I want to say it's secondary...the hamburger-y appearance of the throat (boy is that a great visual prior to dinner) would be semi-consistent with blood soaked chewing tobacco (depending on how big of a user you are, there can be a lot of chewing tobacco in the mouth)...but would also become a non-issue with a little suction...and, I'm sorry, but that's just too "perfect" to be something shot off the engine under pressure (the chances of someone standing over the exact position of an AC valve or the like with their mouth wide open so as to avoid hitting teeth or anything else are so...out there...of course, I'm also guessing that he somehow took a few hundred amps to the back of the throat without getting any electrical burns, so I dunno. I'm not sure where the blueish purple skin would come from, but part of me says that taking a few hundred amps to a spot so close to the spinal column would probably do some damage to the spinal cord, but I also want to say that he would be entirely blueish purple if that were true... And wouldn't there be an electrical burn somewhere on his body denoting the "exit"... Anyway, now I'm really curious, because this sounds so very CSI-y... Link to comment Share on other sites More sharing options...
boeingb13 Posted August 18, 2008 Author Share Posted August 18, 2008 Ok guys, since I will be very busy over the next two days, im going to post what the problems were. 1) The hamburger in the throat, was severe throat cancer due to years of chewing tobacco. 2) The discoloration from the nipple line up was because, he did fall, and threw a PE. I would of never guessed the throat cancer, even after being told the guy didnt go 2 seconds after he woke up with out a mouth full of chew. I'll have some better ones for you coming up soon. I just wanted to throw that one out to see what feedback came back. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted August 18, 2008 Share Posted August 18, 2008 If it wasn't for the blood and "hamburger" appearance I might have guessed epiglottitis. I would consider the esophageal varices also. Any emesis around on the ground, especially bloody emesis? I wonder if esophageal varices with vomiting could cause the esophagus to prolapse into the throat. I don't think so, but it's something I just thought of. Curious where you see epiglottitis or esophageal varacies? I don't see anything anywhere in the scenario that even hints at either of these. In the scenario you can't possibly visualize the epiglottis, and varacies simply isn't a logical assumption here, unless I'm missing something significant. We should try to remember that there are always new people logging on here so that if you're going to hypothesize WAY off into left field, please explain your logic. Otherwise they can spend all of their time being confused by wild ass guesses meant to sound intelligent but having no basis in logical assessment and treatment. I will be interested to have more information on this...at this point I have to think the 'chaw' may have something to do with this, assuming that the description is accurate of "hamburger" in the back of the throat. Dwayne Link to comment Share on other sites More sharing options...
DwayneEMTP Posted August 18, 2008 Share Posted August 18, 2008 Ok guys, since I will be very busy over the next two days, im going to post what the problems were. 1) The hamburger in the throat, was severe throat cancer due to years of chewing tobacco. 2) The discoloration from the nipple line up was because, he did fall, and threw a PE. I would of never guessed the throat cancer, even after being told the guy didnt go 2 seconds after he woke up with out a mouth full of chew. I'll have some better ones for you coming up soon. I just wanted to throw that one out to see what feedback came back. I'll tell you what I like about this scenario....I took us all out of our comfort zone. Not one of us considered a chronic pathology as opposed to acute. Good scenario man...thanks. Dwayne Link to comment Share on other sites More sharing options...
Kaisu Posted August 18, 2008 Share Posted August 18, 2008 Damn... forgot about that nipple line discoloration and PE... Won't forget it again. Thank you for the scenario and Dwayne - you the man! Link to comment Share on other sites More sharing options...
chbare Posted August 18, 2008 Share Posted August 18, 2008 So, now we must ask what can we do for this guy? Massive PE with a massive V/Q mismatch. Do we code him or call him? How do we manage his airway. Will traditional laryngeoscope likely produce good results? Will BLS techniques work? What about a supraglottic airway or fiber optic technology? How will this neoplasm complicate going for a surgical airway? Take care, chbare. Link to comment Share on other sites More sharing options...
Kaisu Posted August 18, 2008 Share Posted August 18, 2008 The guy has no pulse. Prognosis for cardiac arrest due to PE is extremely poor. He has cancer (one of the risk factors for PE). Does he have a DNR ? Depending on how long he's been down, my guess is that we would call it. Even if we decide to work it and get the tube in, how well will we be able to ventilate? If the PE was not huge, the patient would need anticoagulants and thrombolytics - failing this, possibly a specialized surgery. I think this patient is probably ADD (all done dancin'). Link to comment Share on other sites More sharing options...
firedoc5 Posted August 18, 2008 Share Posted August 18, 2008 Curious where you see epiglottitis or esophageal varacies? I don't see anything anywhere in the scenario that even hints at either of these. In the scenario you can't possibly visualize the epiglottis, and varacies simply isn't a logical assumption here, unless I'm missing something significant. We should try to remember that there are always new people logging on here so that if you're going to hypothesize WAY off into left field, please explain your logic. Otherwise they can spend all of their time being confused by wild ass guesses meant to sound intelligent but having no basis in logical assessment and treatment. I will be interested to have more information on this...at this point I have to think the 'chaw' may have something to do with this, assuming that the description is accurate of "hamburger" in the back of the throat. Dwayne You are called to the scene of a 49 y/o male He is on the ground unconsious, he is laying next to a large dumptruck, with a wrench a few feet from him, and the hood is up. He is bluish purple from the nipple line up He has no pulse, and no one saw what happened, they only guess he fell Upon opening his airway you find a lot of blood and what appears to be a traumatic injury to the back of the throat, with the appearance of bloody hamburger meat. What is your assessment, what would you do, but the main thing I'm looking for, is why is this guys throat like this, what could it possibly be? This call threw us for a loop until someone told us something that made it make sense. After a couple responses i'll post the answer. ------------------------------------------------------------------------------------------- I don't believe I was way out there. Like described, "Bloody hamburger meat" appearance in the back of the throat. With "a lot of blood" in the mouth. How much is a lot of blood? You never did state if there was any emesis noted on the ground. Is the blood pooled in the mouth or coming from the mouth? Maybe since I've been around it a lot, but, I can't see where chewing tobacco can be mistaken as bloody tissue. Why can't you visualize the epiglottis or Larynx? Don't you have intubation equipment? Is the cancerous tissue blocking it? If it is, then he must have already been having a lot of raspatory problems already. I have seen where a patient has had epiglottis and had been coughing so hard that it caused trauma to the esophagus, epiglottis, and tongue. If you've ever tubed anyone with epiglottitis you can see where it can be very inflamed, making everything look like a raw oyster. Severe irritation can cause that inflamed tissue to bleed, hence bloody meat. Many times with throat cancer, what comes along with it? Esophageal Varices. Whether it be from tobacco use or chronic alcoholism. Again, another post to call someone out instead of PM'ing to ask personally. :roll: Link to comment Share on other sites More sharing options...
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