crotchitymedic1986 Posted November 10, 2008 Share Posted November 10, 2008 Here is one for the rookies -- too easy for the veterans (and it was a real call). You are called to "weakness" at 3am. You find a healthy looking 30 year old male lying in bed, who claims his legs arent working right. He just feels weak all over. He denies any trauma to his body, no recent illness or fever, no headache or CVA symptoms. He has no previous history other than starting a new exercise routine in the past few weeks. His B/P is 130/80 supine, pulse is rapid at 130-150 (a little fast to count at 3am). His primary and secondary BLS survey are normal. D-Stick is normal. You ask him to sit up for an orthostatic b/p, and you note that he drags his legs off of the bed with his arms, and the legs flop to the floor like that of a paralyzed pt. Now realizing this may be more than the flu -- you question again about trauma, falls, exposure to anyone sick, anything you can think of --- you get nothing. He has sensation in his feet, legs, and rest of body, but just cant move his legs. He doesnt have a fever, no rash, you cant find anything unusual. So you backboard him and move him to the truck --- you decide to put him on the monitor to verify that heart rate --- and i be dadgummed, you are looking at Vtach in lead II (this was before twelve leads and pulse oxs). You check his b/p --still 130/80, A&OX3, no pain. You check lead 1, still Vtach -- you check lead III, which shows SVT - but the other two leads are still textbook Vtach. What is wrong with this patient ??????????? Link to comment Share on other sites More sharing options...
mshow00 Posted November 10, 2008 Share Posted November 10, 2008 Is the pulse weak? Is there a difference in b/p from arm to arm? What about pedal/sacral edema? For starters it sounds like his heart rate is to fast to properly profuse his extremities. Depending on those answers, I would treat him as stable V-Tach (150 mg Amioderone over 10 mins and then drip of 900mg/500cc ran at 1 mg/min for the first 6 hrs [etc]). At least this is my inital thoughts, correct me if I have missed something please. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted November 10, 2008 Author Share Posted November 10, 2008 The answer to all of your questions is NO --- his exam is totally unremarkable except for the leg weakness and the possible VTACH -- remember one lead shows SVT. As far as treatment, i dont want to give the answer away until a few others have chimed in, but feel free to ask questions, or better yet -- why dont you and everyone else post your best three diagnosis' for this patient, before we move into treatment. Link to comment Share on other sites More sharing options...
fenwayfrankee Posted November 11, 2008 Share Posted November 11, 2008 AAA Link to comment Share on other sites More sharing options...
Mateo_1387 Posted November 11, 2008 Share Posted November 11, 2008 Thyrotoxic Hypokalemic Periodic Paralysis Link to comment Share on other sites More sharing options...
Kaisu Posted November 11, 2008 Share Posted November 11, 2008 guillaume barre Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted November 12, 2008 Author Share Posted November 12, 2008 way to go mateo -- you hit it on the head. The clue was the new exercise routine, which also included a new crazy fad diet (at 3am i didnt think to ask about that). His potassium bottomed out which caused the muscle weakness and arrythmia. A little KCL in his IVbag and he was as good as new. Link to comment Share on other sites More sharing options...
Riblett Posted November 13, 2008 Share Posted November 13, 2008 Kick ass Matt! Link to comment Share on other sites More sharing options...
Kaisu Posted November 13, 2008 Share Posted November 13, 2008 oh Matt - you sooooooo smart - and handsome toooooo Link to comment Share on other sites More sharing options...
firedoc5 Posted November 13, 2008 Share Posted November 13, 2008 oh Matt - you sooooooo smart - and handsome toooooo Sounds like someone has a crush on you, Matt. :love8: Link to comment Share on other sites More sharing options...
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