chbare Posted May 24, 2011 Share Posted May 24, 2011 You are called to respond to a rural emergency room where a 27 year old male diagnosed with altered mental status will be transferred to a large, subspecialty centre for services unavailable at the sending facility. Take it from here. Take care, chbare. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 24, 2011 Share Posted May 24, 2011 You are called to respond to a rural emergency room where a 27 year old male diagnosed with altered mental status will be transferred to a large, subspecialty centre for services unavailable at the sending facility. Take it from here. Take care, chbare. I'd like to know the following how long has he been this way any out of country travel? Any strange food consumption in honor of Andrew Zimmern Rural emergency room labs, x-rays and tests would be great 12 lead blood sugar etc etc etc trends in the vital signs if possible. Link to comment Share on other sites More sharing options...
chbare Posted May 24, 2011 Author Share Posted May 24, 2011 I'd like to know the following how long has he been this way any out of country travel? Any strange food consumption in honor of Andrew Zimmern Rural emergency room labs, x-rays and tests would be great 12 lead blood sugar etc etc etc trends in the vital signs if possible. 1) Progressively worse over 36 hours, started with flu like symptoms. 2) Nope. 3) Nope. 4) What X-rays and tests do you want? 5) Sinus tachycardia. 6) 830 mg/dl 7) Increased respiratory rate and pulse. Take care, chbare. Link to comment Share on other sites More sharing options...
zippyRN Posted May 24, 2011 Share Posted May 24, 2011 1) Progressively worse over 36 hours, started with flu like symptoms. 2) Nope. 3) Nope. 4) What X-rays and tests do you want? Full Blood Count, Urea and Electrolytes, bilirubin, amylase, lactate , lab glucose , ABG (or VBG for pH) , urine dip ( for signs of infection and Glucose), have blood cultures been drawn ? chest X- ray is always a start as part of the sepsis screen, AXR /AUSS if anything significant on abdo exam has he got a temperature ? 5) Sinus tachycardia. 6) 830 mg/dl 46 mmol/ l ??? is this a lab result on venous blood or from Near Pt Testing - if it's NPT, repeat the stick with scrupulous skin prep and a lab sample please ... 7) Increased respiratory rate and pulse. Allergies ? medications ? Past Medical History? Last ate ? the pattern from the description given sounds as though it may be Ketoacidosis / HONK with possible infection / sepsis on top ... unless it;s an epsidoe of 'House' , when it will be Lupus ... Link to comment Share on other sites More sharing options...
chbare Posted May 24, 2011 Author Share Posted May 24, 2011 Full Blood Count, Urea and Electrolytes, bilirubin, amylase, lactate , lab glucose , ABG (or VBG for pH) , urine dip ( for signs of infection and Glucose), have blood cultures been drawn ? chest X- ray is always a start as part of the sepsis screen, AXR /AUSS if anything significant on abdo exam has he got a temperature ? Unremarkable chest film except for slight underinflation of the lower lobes, AGB shows an uncompensated metabolic acidosis, CBC shows an elevated white count, UA is positive for glucose, serum lactate is elevated, BUN and creatine are elevated, no blood cultures. Temp is 100.2 F. 46 mmol/ l ??? is this a lab result on venous blood or from Near Pt Testing - if it's NPT, repeat the stick with scrupulous skin prep and a lab sample please ... This is a reliable finding. Allergies ? medications ? Past Medical History? Last ate ? NKA, Insulin pump at home, IDDM, Attempted 24 hours ago. the pattern from the description given sounds as though it may be Ketoacidosis / HONK with possible infection / sepsis on top ... unless it;s an epsidoe of 'House' , when it will be Lupus ... Anybody interested in a physical exam or clinical findings beyond what has already been discussed? Take care, chbare. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 24, 2011 Share Posted May 24, 2011 Anybody interested in a physical exam or clinical findings beyond what has already been discussed? Take care, chbare. Yes, I'm wanting to know the following cap refill sclera appearance skin turgor Any skin abnormalities like rash or problem there What do his mucous membranes look like, particularly his tongue, inside the cheeks and back of throat. what are his tonsils like? What color is his urine? concentrated or not? last bowel movement - loose, formed, pencil thin? What are his orthostats? I don't think I saw a 12 lead reported? Link to comment Share on other sites More sharing options...
chbare Posted May 24, 2011 Author Share Posted May 24, 2011 Yes, I'm wanting to know the following cap refill sclera appearance skin turgor Any skin abnormalities like rash or problem there What do his mucous membranes look like, particularly his tongue, inside the cheeks and back of throat. what are his tonsils like? What color is his urine? concentrated or not? last bowel movement - loose, formed, pencil thin? What are his orthostats? I don't think I saw a 12 lead reported? Delayed, tinting noted, dry membranes, tonsils are unremarkable, urine is concentrated, loose stool 24 hours ago, the nurse is rather concerned about the breathing when you attempt to do orthostatic assessments, 12 lead as stated above. Take care, chbare. Link to comment Share on other sites More sharing options...
rock_shoes Posted May 25, 2011 Share Posted May 25, 2011 Plenty of good questions thus far but let's not get ahead of ourselves without going through our basic patient assessment. Let's get a BP, Temp, HR, GCS, etc. before we go racing down any particular path. Link to comment Share on other sites More sharing options...
chbare Posted May 25, 2011 Author Share Posted May 25, 2011 Plenty of good questions thus far but let's not get ahead of ourselves without going through our basic patient assessment. Let's get a BP, Temp, HR, GCS, etc. before we go racing down any particular path. 100/60, HR 138, GCS is around 13. Take care, chbare. Link to comment Share on other sites More sharing options...
Bernhard Posted May 25, 2011 Share Posted May 25, 2011 (edited) respond to a rural emergency room where a 27 year old male diagnosed with altered mental status Before we do all our lab, X-ray and fancy stuff ourselves (I'm surprised what you really have in your ambulances, whow...): what is the complete diagnosis of the ER docs? Simply "altered mental status" is not their whole finding, I hope... Unless I have a complete misunderstanding of the ER setting at this site. Please correct me then. Edited May 25, 2011 by Bernhard Link to comment Share on other sites More sharing options...
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