mshow00 Posted October 20, 2008 Share Posted October 20, 2008 My former partner told me about this call she had today, I have no clue so I thought I would share here: Called out for 44 y/o female unresponsive... AOS to find 44 y/o woman in bed laying in the right recovery position (exactly as she feel asleep) she presents with a bloody sputum/emesis coming out of her mouth, on her bed and on her clothes. She appears to have facial droop. She responds to verbal stimuli, attempts to verbally respond but can not. Mother states pt has an unknown neuro deficit history. (Pt appears to have long term neuro deficit that runs in family) Mother states pts only other history is stomach ulcers. V/S: B/P:142/58 P:120 R:20 slightly labored and SPO2: 84% on Room Air BGL: 146 BBS: Rhonchi (all fields) Skin: extremities-cold and dry core-hot and diaphoretic Pupils: PERRL 3lead: Sinus Tach w/o ectopy. Pt denies chest pain, head ache, and has equal weakness on both sides. Paramedic established 18 GA NS lock in Left hand, placed on 4LPM( O2 sats increase to 95% with single Albuterol tx) Transported to ER 3 miles away... Anyone care to venture a guess at what is wrong with her? (if you need more info please ask and I will do the best I can to obtain the answers) Link to comment Share on other sites More sharing options...
vs-eh? Posted October 20, 2008 Share Posted October 20, 2008 Postictal... I don't know what that means... You also said that she "attempts to respond verbally but can not", but then denies chest pain, head ache... I don't know why the ventolin tx was given... Wheezes can mean a lot here (like it's an upper airway issue) given the situation, and I would not have given this treatment.... Link to comment Share on other sites More sharing options...
mshow00 Posted October 20, 2008 Author Share Posted October 20, 2008 Postictal... postictal does not fit as she is alert and apparently oriented, the V/S dont really fit nor does the scene give the impression. The bed is in perfect order save where she slept, and she does not fit your typical postictal state. No history of seizures (which I know does not mean a lot). I don't know what that means... Almost as if her and her brother have some degree of MR, or similar life long neuro deficit. You also said that she "attempts to respond verbally but can not", but then denies chest pain, head ache... She can not speak but can shake her head. I don't know why the ventolin tx was given... Wheezes can mean a lot here (like it's an upper airway issue) given the situation, and I would not have given this treatment.... I dont have an answer for that yet but wil try. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted October 21, 2008 Share Posted October 21, 2008 How does the inside of her mouth look? Are we sure that the bloody sputum isn't pulminary edema? Link to comment Share on other sites More sharing options...
itxtme Posted October 21, 2008 Share Posted October 21, 2008 I would have guessed Chest Infection based on 1) Bloody Sputum 2) Decreased Saturation 3) Rhonci bi-lat on auscultation 4) Tachycardia - infection BSL is getting up there - pmhx type 2? How you describe the core boy indicates compensation... Extremities constrict, core dilates.. Working diagnoses would be Chest Infection Epiglottitis (could account for facial droop + drooling) Could be TIA, CVA Pt questioning Chest pain on palpation? Grip strength tests.. WHy cant she speak - Pain? Abdo? Link to comment Share on other sites More sharing options...
mshow00 Posted October 21, 2008 Author Share Posted October 21, 2008 How does the inside of her mouth look? Are we sure that the bloody sputum isn't pulminary edema? That was one of my thoughts; Flash PE secondary to sudden onset L CHF. I also though prolonged hypoxia (with end organ damage) due to a CVA/TIA or SZ, or an apneic period the night before. My partner saw the ER doc yesterday and asked about the pt. The doctor said the pts only issue was being acidic (unknown what the pH was). Never would have guessed that. Link to comment Share on other sites More sharing options...
chbare Posted October 21, 2008 Share Posted October 21, 2008 Need to push for more information. Acidosis is usually related to the underlying condition. Take care, chbare. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted October 21, 2008 Share Posted October 21, 2008 That was one of my thoughts; Flash PE secondary to sudden onset L CHF. I also though prolonged hypoxia (with end organ damage) due to a CVA/TIA or SZ, or an apneic period the night before. My partner saw the ER doc yesterday and asked about the pt. The doctor said the pts only issue was being acidic (unknown what the pH was). Never would have guessed that. See if they can find what the cause of it was. At THIS point, acidosis sounds respiratory in nature...84% RA? I'd be curious as to the cause. Link to comment Share on other sites More sharing options...
firedoc5 Posted October 21, 2008 Share Posted October 21, 2008 Prolonged smoker? Pneumonia? COPD? Inhaled any unusual fumes lately? First time crack smoker? Any nasal congestion? EN&T observed? "Skin: extremities-cold and dry core-hot and diaphoretic" ??? Something just doesn't sounds kosher all the way around. :scratch: Even with improvement with O2 sat. I'd still increas it it to 12 L per NRM. Any new construction or utility work in the near area? Link to comment Share on other sites More sharing options...
Arizonaffcep Posted October 21, 2008 Share Posted October 21, 2008 I would wonder maybe septic? Maybe chemical exposure? Link to comment Share on other sites More sharing options...
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