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Puzzling patient


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The only issue I would have with chemical restraint ( besides I dont have a protocol for it) is that if he is going down hill, its going to be harder to detect any continuing change in LOC. If given the choice it'd prefer to use my own fabric style restraints instead of hand cuffs if he if going to be fighting alot, easier on the patient, and gives something nice and long to hang onto when transferring from cot to bed. I agree with a psyc diag. but i've been surprised before.

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Depending on how rowdy we are, psych drugs can go a long way to being safe and preventing further issues on down the road. In addition, they most likely will be utilitzed in the ER in addition to leather and/or fabric restraints. I most certainly wouldn't go the handcuff route that's for sure. I would be having med control on board with me though for this one.

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Patient was found lying in the middle of the room with no apparent items that he would have struck his head.

Except, umm, the floor.

It's a long short I know, but I'd probably be of the mind that I cannot rule trauma out in this scenario, so I have to rule it in. Yes, later proven to not be the case, but I can't always do that in the field.

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I think this is a psych issue. Bipolar just went threw a traumatic experience looks up to us yucks and freaks. Blood sugar could be up due to pysch meds and unknown med history but I have dealt with bipolar people before and its a wild ride and unfortunately there is no exact science to the meds they take it is sadly trial and error and this could be error. One thing i have a question about is did the patient respond better or worse to a opposite gender person then themselves or same gender its weird but some times bipolar people react differently and you have to change up who is dealing with them. Also tho the numbers dont indicate it yet they are heading towards a stroke consideration and I think some pysch meds have a problem with that.

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I noticed that we were told at some point that the burnt eggs in the pan were still in the shell. To me, this indicates that the altered LOC was present before the fire, rather than a result of the fire. I'm wondering if it could be some kind of psycological break. I've known a lot of bipolars and they have never presented this out of it. They may not have been rational, but they were coherent. I'm also wondering if maybe this patient has some sort of issues(i.e.-hepatitis, etc.) that could be interfering with how he is processing his medications and causing a toxicity at what would otherwise be a normal dose. Maybe he was miss diagnosed with bipolar and actually has something more along the lines of schizophrenia(could also explain the eggs still in the shell) or borderline personality? Just throwing some thoughts out there.

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At the time of this incident chemical and soft restraints were unavailable. Chemical restraint is not in the county protocol, and for some reason we don't have soft restraints on the trucks. I am looking at fixing that problem. I did get end stage follow-up and talked to with the medical director. Per OSU Medical Center where the patient was transferred to, CT scans negative, Tox screen negative, cultures negative, CBC and BMP were within WNL. Patient was discharged home to care of his PMD with a psychotic episode of unknown etiology. In talking with the medic director, seratonin syndrome, would be logical, but local facility doesn't have capability to draw it, and apparently OSU didn't draw it. To answer the question the patient wasn't less combative with a particular sex. Thanks for the input on this.

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  • 2 weeks later...

How old is pt. Didn't see an age. Any intial cyanosis. Any med history other then psyc. What room pt found in.

It sounds like hypoxia which then agrevated the psyc history. Does pt have any violent history due to the bipolar?

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