FireMedic65 Posted April 19, 2009 Share Posted April 19, 2009 so since I know the outcome I should say it then making this ems discussion??? no, let the people discuss it and see if someone can figure it out. next time, post a scenario in the scenario section though. people get upset when you post in the wrong place for some reason Link to comment Share on other sites More sharing options...
mobey Posted April 19, 2009 Share Posted April 19, 2009 could be postictal..... although I would expect the resp rate and pulse to be higher Could be Narc use What does the scene look like? Is there trismus present? Any vomit? What does his breath smell like? High flow O2 IV NaCl 30ml/hr Re-check BGL with a different monitor Get intubation equipment ready RSS with Midaz and fentanyl (Probably won't need paralytics unless gag reflex is intact) EtCo2 DD at this time is injestion of toxin (meds, alcohol, fingernail polish..... who knows) Could be neuro too Either way, we have an UnCx pt whom cannot protect thier airway and cannot be reversed anytime soon. Secure an airway and head to nearest hospital (preferably one with CT) Link to comment Share on other sites More sharing options...
NYCEMS Posted April 19, 2009 Author Share Posted April 19, 2009 no, let the people discuss it and see if someone can figure it out. next time, post a scenario in the scenario section though. people get upset when you post in the wrong place for some reason Yeah I got that the first time....I guess your one of those people? could be postictal..... although I would expect the resp rate and pulse to be higher Could be Narc use What does the scene look like? Is there trismus present? Any vomit? What does his breath smell like? High flow O2 IV NaCl 30ml/hr Re-check BGL with a different monitor Get intubation equipment ready RSS with Midaz and fentanyl (Probably won't need paralytics unless gag reflex is intact) EtCo2 DD at this time is injestion of toxin (meds, alcohol, fingernail polish..... who knows) Could be neuro too Either way, we have an UnCx pt whom cannot protect thier airway and cannot be reversed anytime soon. Secure an airway and head to nearest hospital (preferably one with CT) , don't no what trismus means, no vomit, pt breath smells of alcohol. Pt bedroom messy but nothing unusual. Since you and I are the only night owls would you like to know the findings. Link to comment Share on other sites More sharing options...
mobey Posted April 19, 2009 Share Posted April 19, 2009 sure..... Could be anything from cerebral edema to infection http://www.oralcancerfoundation.org/dental/trismus.htm Link to comment Share on other sites More sharing options...
oz_paramedic_chick Posted April 19, 2009 Share Posted April 19, 2009 I'd also have a quick look in the mouth. Is there any blood present or bite marks on the tongue that might help strengthen suggestions of a seizure? Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 19, 2009 Share Posted April 19, 2009 Yeah I got that the first time....I guess your one of those people? No, I am not. I was just re-stating the point of each section again since you asked if you should give the answer. Link to comment Share on other sites More sharing options...
NYCEMS Posted April 19, 2009 Author Share Posted April 19, 2009 No, I am not. I was just re-stating the point of each section again since you asked if you should give the answer. I apologise. Well the pt was found to have suffered a ponds bleed. It seems since the pt never went to the hospital he probably had uncontrolled hypertention. The pt stroked out over night and vidals just went back to normal after the stroke. Due to the location of the bleed is why both pupils were constricted. A medic that responded actually went over the pt with me on scene to explain the possible ponds bleed. I had suspected stroke due to pt's alcohol abuse and lack of medical attention. The diagnosis was confirmed at the hospital with a ct scan. Unfortunaetly this pt will be on life support for the rest of his life. Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 19, 2009 Share Posted April 19, 2009 I apologise. Well the pt was found to have suffered a ponds bleed. It seems since the pt never went to the hospital he probably had uncontrolled hypertention. The pt stroked out over night and vidals just went back to normal after the stroke. Due to the location of the bleed is why both pupils were constricted. A medic that responded actually went over the pt with me on scene to explain the possible ponds bleed. I had suspected stroke due to pt's alcohol abuse and lack of medical attention. The diagnosis was confirmed at the hospital with a ct scan. Unfortunaetly this pt will be on life support for the rest of his life. that's a shame. good scenario though. Link to comment Share on other sites More sharing options...
celticcare Posted April 19, 2009 Share Posted April 19, 2009 Reaching a climactic peak and then pop and then whittling down to semi heamostasis in regards to the BP, pulse, resps. Only problem now, is that he has blown his cerebral cortex and is now reliant on his primate brain to function, which wont be for much longer. I would have gone down the same path as Mobey, ascertain vitals, check for response potentially to narcan, intubate, two IVL, transport to CT scanner. The alcohol and substance abuse for years whittled down the arterioles and veins until climactically BOOOM. Hope that last drink was worth it. Thanks NYCEMS, I was thinking along CVA, postdictal from withdrawl seizure, trauma or meningitis type symptoms. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2009 Share Posted April 19, 2009 I apologise. Well the pt was found to have suffered a ponds bleed. It seems since the pt never went to the hospital he probably had uncontrolled hypertention. The pt stroked out over night and vidals just went back to normal after the stroke. Due to the location of the bleed is why both pupils were constricted. A medic that responded actually went over the pt with me on scene to explain the possible ponds bleed. I had suspected stroke due to pt's alcohol abuse and lack of medical attention. The diagnosis was confirmed at the hospital with a ct scan. Unfortunaetly this pt will be on life support for the rest of his life. Do you mean a hemorrhage of the pons? Also known as a pontine hemorrhage. Take care, chbare. Link to comment Share on other sites More sharing options...
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