Sudden Need to Deficate

[Eydawn]

Hm. Diverticulitis, perhaps? Triggered by eating certain foods, causes distress, mild shocky-symptoms, and quick resolution because she has good general health?

Also, perhaps she has a vagal response during her funky bowel flare, causing the decreased MAP and "whited out/blurry" vision? Which resolves once she's done sitting on the pot?

Odd!

Wendy

CO EMT-B

RN-ADN Student

[Just Plain Ruff]

Is she on Metformin perhaps?

Might she just had to have to have gone crap?

Sometimes there are just times that I have to just go. No rhyme or reason folks. There are just times when you gotta go. And seriously, do you need to call an ambulance for those times?

But she felt the need so we are here so carry on.

But the dizziness could just be the post strain vagal response.

I'd transport the nice lady to the ER. IV and monitor and watch her.

There is an underlying etiology that there is no way that we are going to catch so let's let the big guns in the hospital watch her overnight and do serial cardiac markers.

Maybe do a cardiac stress test and whatever else they do.

she definatley does not warrant going to a small hospitla that cannot do the cardiac workup. She needs a facility that can work her up for a cardiac/neuro workup.

Wish her well and call her in a week and see what the find out. She might need a holter monitor as well to see what they can find for a 24 hour period as well.

Edited July 27, 2012 by Captain ToHellWithItAll

[CytochromeP450]

Some excellent ideas by all posting here. I was certainly stumped when I saw her.

My primary thought was that it was a vagal event, but that would make more sense if she had been pushing hard, but the stool was loose and all symptoms seemed to start together more or less. I also thought it might be some sort of gnarly arrhythmia that was self limiting.

I mentioned the case to an old doctor that frequents these parts and he said it sounded a lot like Dumping Syndrome. I had never heard of it before but after looking into it, it sounds like the symptoms are spot on. The patient didn't mention previous gastric surgery and she had no scars on her abdomen, but I imagine there is a possibility that the problem could have an idiopathic origin.

This case is quite the reach for any prehospital provider to pick up on, but interesting and good to know regardless.

[emtdennis]

Very interesting, seems like it can happen even without the history of gastric surgery.

[Just Plain Ruff]

Some excellent ideas by all posting here. I was certainly stumped when I saw her.

My primary thought was that it was a vagal event, but that would make more sense if she had been pushing hard, but the stool was loose and all symptoms seemed to start together more or less. I also thought it might be some sort of gnarly arrhythmia that was self limiting.

I mentioned the case to an old doctor that frequents these parts and he said it sounded a lot like Dumping Syndrome. I had never heard of it before but after looking into it, it sounds like the symptoms are spot on. The patient didn't mention previous gastric surgery and she had no scars on her abdomen, but I imagine there is a possibility that the problem could have an idiopathic origin.

This case is quite the reach for any prehospital provider to pick up on, but interesting and good to know regardless.

Thus the reason why I asked if she was on metformin. My endocrinologist warned me about dumping syndrome when I first was put on metformin as that was a classic side effect of the metformin, loose stools and dumping effect. He didn't quite call it dumping effect but when I first started taking it he said, "Mike, make sure you aren't too far away from a toilet for the first week or so as this medicine until your gut is used to it, may make you shit your pants". Boy was he right one day. I didn't make it to the toilet on the day that I ramped up my dose to 1000mg in the morning, 500 at lunch and then 1000mg at night which of course was a mistake by me in what I heard the doc say. I misheard him say the 1000 at night. I was only to take 500 at night. so in other words my night dose was incorrect. So at 10pm I had a little dumping effect but it wasn't in the toilet but close to it.

Personal story with TMI I know but I had all the ladies symptoms as well. my wife was quite concerned, she was checking my sugar, it was normal for me, she was checking the pulse and all that and we chalked it up to just a vagal issue.

I went and lay down and it passed.

Called the doc, he called back and said "NO I said blah blah blah 500 at night" so we adjusted.

Long story short, Alls good that ends good. Patient seems to have done well on your end.

[DwayneEMTP]

Man, great case.

For the record, at the top of my list of differentials was a transient arrhythmia, but you douched that idea before I had a chance to mention it...

Thanks Brother, that was educational!

[Happiness]

I have been thinking on this one and here is a long shot. My question would be where did all of these episodes happen and were they under the same circumstatnces. My husband told me long ago not to have incense burning in the house. For some reason as soon as he entered the house with them going he would have to go to the bathroom. So me being me I had to test this, because I figured he was just saying this because he didnt like the smell. So one day had the incense going and low and behold he walked through the door, one sniff and he ran to the bathroom. Needless to say I dont burn incense anymore

[DFIB]

I received a True Health pamphlet in the mail yesterday, promoting some kind of super-duper roto-rooter colon cleanse, The pamphlet headlined; Poop every day! NO strain! NO pain! NO kidding! and Wiping,wiping and still smearing? Here's what your toilet paper is saying about your health ... It is a hoot!

,

So, this gets me thinking that if a person suffers from constipation that distended their colon (you know like John Wayne and his 40 lbs of poop), and were suddenly evacuated, a considerable empty space would be created in the abdomen that might decompensate the BP, and possibly contribute to a vagal reaction.

[DwayneEMTP]

You need to find the one that gives him a woody as soon as he smells it...I'll bet he'll complain about it less... :-)

[DFIB]

You need to find the one that gives him a woody as soon as he smells it...I'll bet he'll complain about it less... :-)

But he could crap himself to death before she found the right smell! Once she found it she could burn them at the same time! Confusing as heck!

Edited July 27, 2012 by DFIB