Timmy Posted December 8, 2008 Share Posted December 8, 2008 Well that sounds convenient... I'm not really up to scratch with blood tests in my 5 months as a student nurse but I guess an FBC because I'd like to see what the go is with haemoglobin, platelets, lymphocytes, WBC ect to rule out any infection or funky blood problems. Maybe even a tox screen. I'd like to do a full head to toe assessment. Does it reveal anything? Is there any oedema in the feet/leg? Is there any family history of anything like MS or motor neuron problems? What's his BGL like? No history of diabetes in the family? Has he had any wounds either visible or ones that are healed in the last few months? If so, did he happen to sustain this while climbing the tree, even a minor abrasion? Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 The CT and Xray have come back negative, wouldn't spinal compression, herniated disks and stress fractures be picked up on this? When you say he drags his foot, is this dragging like a Shuffling Gait? He has no Bradykinesia or anything like this? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 9, 2008 Share Posted December 9, 2008 if he is a tree trimmer does he use a harness? if he uses a harness could the harness not have impinged on a nerve in his leg or pelvis or hip? If so, then let's do an MRI of the lumbar spine, the pelvis and the femoral area. Link to comment Share on other sites More sharing options...
ERDoc Posted December 9, 2008 Author Share Posted December 9, 2008 Well that sounds convenient... I'm not really up to scratch with blood tests in my 5 months as a student nurse but I guess an FBC because I'd like to see what the go is with haemoglobin, platelets, lymphocytes, WBC ect to rule out any infection or funky blood problems. Maybe even a tox screen. I'd like to do a full head to toe assessment. Does it reveal anything? Is there any oedema in the feet/leg? Is there any family history of anything like MS or motor neuron problems? What's his BGL like? No history of diabetes in the family? Has he had any wounds either visible or ones that are healed in the last few months? If so, did he happen to sustain this while climbing the tree, even a minor abrasion? There is no edema. No family history, BGL is 100. All labs come back normal. No recent wounds. Head to toe is as previouly described. Link to comment Share on other sites More sharing options...
ERDoc Posted December 9, 2008 Author Share Posted December 9, 2008 The CT and Xray have come back negative, wouldn't spinal compression, herniated disks and stress fractures be picked up on this? When you say he drags his foot, is this dragging like a Shuffling Gait? He has no Bradykinesia or anything like this? Head to toe CT, MRI, xrays, US, tricorder are all negative. No shuffling gait. When he goes to lift the foot off the ground to swing it forward he is unable to dorsiflex and drags the toes (drop foot). Link to comment Share on other sites More sharing options...
ERDoc Posted December 9, 2008 Author Share Posted December 9, 2008 if he is a tree trimmer does he use a harness? if he uses a harness could the harness not have impinged on a nerve in his leg or pelvis or hip? If so, then let's do an MRI of the lumbar spine, the pelvis and the femoral area. He uses a harness that straps around both knees and has small spikes that he uses to dig into the trees for traction. MRI as described above. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 9, 2008 Share Posted December 9, 2008 Does he have any open sores on his body ? Any ticks been removed lately, or still present ? Is there any swelling, redness, or edema to affected extremity ? Link to comment Share on other sites More sharing options...
ERDoc Posted December 9, 2008 Author Share Posted December 9, 2008 Does he have any open sores on his body ? Any ticks been removed lately, or still present ? Is there any swelling, redness, or edema to affected extremity ? No, no and no. Link to comment Share on other sites More sharing options...
EMT Foose Posted December 9, 2008 Share Posted December 9, 2008 This just screams of nerve damage, only trouble is finding the mechanism. I'm not betting on an obscure medical condition just yet, still thinking trauma.. The defecit is local, so the mechanism must be as well. Perhaps some type of ischemic damage to the nerve running through the knee..? How long does he typically sit with his weight on the sling? How long was he in that position today? Has he ever experienced ANYTHING similar or heard of something like this from his colleagues? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 9, 2008 Share Posted December 9, 2008 I know we xrayed/scanned his spine and leg ? Have we done an MRI on his brain ? If we have, and it was negative, then I say transport him to the hospital that "House" works at. Link to comment Share on other sites More sharing options...
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