joesph Posted June 9, 2009 Share Posted June 9, 2009 ok in way to deep but I'll play at basic level I would make a good survey of the room and contents anything note worthy? put him on O2 and get him moving toward difinative care. But just to stay in the game I would like ask if any research into his brothers condition can be done by e-mail. Also question on diet or weight change looking for a reason for a gall bladder problem. Liver enzymes might be interesting. Like I said we left my level of care behind several miles ago but i'm leaning toward the hernia. Oh yeah any chance he got local water he might have drank a critter Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2009 Author Share Posted June 9, 2009 No definitive care at this point. You have to justify calling for an extraction. This means a physician and a medic from the main clinic along with a quick reaction force convoy element to pick up the patient and bring him back to the main clinic. So, you are about as definitive as it gets for now. Do you think this guy can wait? You will have to decide if he is critical and requires emergenct extraction. However, you need to present a good case to the doctor that will be putting her neck on the line by driving out to pick this patient up, if you are looking at an evacuation. It is the middle of the night at brothers house, and nobody answers the phone or email. However, this could be something that runs in the family. Something to consider? It looks like people are leaning toward a liver problem? Clearly, checking liver enzymes may be a good idea. However, you are going to draw blood and have results tomorrow. So, it would be unreasonable to piece meal your labs. We need to decide the essential labs at this point. If LFT's are the only essential labs, I will give them to you; however, is there anything else you want? He has eaten local food and I would not fault you for considering the possibility that he picked up a new friend from such activity. This scenario is not beyond you. Feel free to do some research and develop a list of differentials. Then, we can continue to rule out during this discussion. Please describe why you suspect a hernia? What type of hernia are you considering? Take care, chabre. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 9, 2009 Share Posted June 9, 2009 I would ballpark a liver problem simply because of the size of the liver in relation to the RUQ; but it could very well be something else. How large is this mass? Like are we talking a pimple or golf ball sized? It could be a herniated liver. Link to comment Share on other sites More sharing options...
FireMedic65 Posted June 9, 2009 Share Posted June 9, 2009 what kind of fuel is he working around? Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2009 Author Share Posted June 9, 2009 I would ballpark a liver problem simply because of the size of the liver in relation to the RUQ; but it could very well be something else. How large is this mass? Like are we talking a pimple or golf ball sized? It could be a herniated liver. No so much an isolated mass, as a general enlargement of the liver. Or, so you suspect. Take care, chbare. what kind of fuel is he working around? Primarily diesel. Take care, chbare. Link to comment Share on other sites More sharing options...
11BVet Posted June 9, 2009 Share Posted June 9, 2009 I don't think a detailed exam has been done, I am mainly looking for lesions, based on the A/O I am thinking a sandfly might have gotten a free meal off of the pt. Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2009 Author Share Posted June 9, 2009 I don't think a detailed exam has been done, I am mainly looking for lesions, based on the A/O I am thinking a sandfly might have gotten a free meal off of the pt. It has; however, I am answering specific questions at this point. Nope on the sandfly theory. Thus far we have LFT's, and the reasoning is pretty obvious given our abdominal findings. What else would you guys like to know? Take care, chbare. Link to comment Share on other sites More sharing options...
joesph Posted June 10, 2009 Share Posted June 10, 2009 Ok did we get a blood sugar? Can we have another set of vitals assuming its been about 15 min. Looking into hernias the best fit so far is a diaphragmatic in which case this dude may need a surgeon. Also a pyogenic liver abscess could fit. Also requiring a stay in the white house. As far as a major campaign to get this guy to a doctor or visa versa. What options do we have anythig less then a major campaign available? I think this person needs to be moved out of there and to a location where he can be observed and monitored. Lets get a IV open to have access if needed. He appears to be stable at the time but unless blood work can be gathered and processed in a timely manner I think I would arrange transport to a place where meds are available as well as imaging equipment. In this senario what tools do we have at our disposal med, IV, monitoring equipment and so on. It also comes to mind that he has been dealing with this problem for 3 months and now its bad enough to call for assistance it may not be emergent but its not trivial. Also anybody in a camp like this I would assume have a physical on file any chance on getting that. Link to comment Share on other sites More sharing options...
chbare Posted June 10, 2009 Author Share Posted June 10, 2009 (edited) Blood sugar as stated earlier. Vital signs are unchanged. With a diaphragmatic hernia, what findings would you suspect? Would most people with diaphragmatic hernias tolerate the condition for three months? Soonest possible time for evac is 72 hours, and the evac doctor on call is not convinced this guy needs to be emergently extracted and evacuated yet. You can have your labs in about 12-24 hours. What do you want and why? Thus far, all we have are LFT's. If this is all, I can give you the findings. Lets say I throw in another complaint that the patient initially did not tell you. He complains of hand and knee joint pain starting about three months ago with the other symptoms. You have IV access. EDIT: His employment physical 2 years ago was unremarkable. Take care, chbare. Edited June 10, 2009 by chbare Link to comment Share on other sites More sharing options...
joesph Posted June 10, 2009 Share Posted June 10, 2009 Ok can I have some blood work sent out CMP CVC LFP and a urine tox screen Link to comment Share on other sites More sharing options...
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