mobey Posted July 31, 2012 Share Posted July 31, 2012 OK, the title was to get you reading. Now that I've got you... Called to the fair grounds where the Carnival crew is in town. Looking for a 28y/o who has been electrocuted. There you find 20+ "Carnies" drinking and having a good time. You ask for the patient, and a 6'4 340lb young man walkes over and introduces himself. He is in no obvious distress, however is holding his hands out in front of him as if they were soaking wet (if you get the picture). He is slurring his speech slightly, and has ETOH on his breath. He states that he was sittng on a step drinking rum & Coke, when he started to get tingling in his fingers, that has now turned into an "electric feeling" in both his arms from the elbow down. It is 2am Warm summer day BP 188/92 HR 76 RR 22 Sp02 99 BGL 10.2mmol Temp 36.6 (normal) Medications: Metoprolol, ASA 81mg, atorvastatin. PmHx: Pre-diabetes, MI w/Stent x14mos ago. Hyperlipidemia, Hypertension, Smoker - 7 pack-year. 1 Link to comment Share on other sites More sharing options...
Vorenus Posted July 31, 2012 Share Posted July 31, 2012 OK, the title was to get you reading. Now that I've got you... Called to the fair grounds where the Carnival crew is in town. Looking for a 28y/o who has been electrocuted. There you find 20+ "Carnies" drinking and having a good time. You ask for the patient, and a 6'4 340lb young man walkes over and introduces himself. He is in no obvious distress, however is holding his hands out in front of him as if they were soaking wet (if you get the picture). He is slurring his speech slightly, and has ETOH on his breath. He states that he was sittng on a step drinking rum & Coke, when he started to get tingling in his fingers, that has now turned into an "electric feeling" in both his arms from the elbow down. It is 2am Warm summer day BP 188/92 HR 76 RR 22 Sp02 99 BGL 10.2mmol Temp 36.6 (normal) Medications: Metoprolol, ASA 81mg, atorvastatin. PmHx: Pre-diabetes, MI w/Stent x14mos ago. Hyperlipidemia, Hypertension, Smoker - 7 pack-year. Headache? Dizziness? Vommiting? Nausea? Any obvious marks with the neurological examination that could be separated from his ETOH intake? Pupils, etc.? SOB? Thoracic Pain? Any traumatic injury prior? Heavvy Lifting? Prior problems with back/spine? First thought says either cerebral problem or propable spinal/nerve thingy, although presentation would be kinda weird with only both arms being affected... Circulation/motivity/sensibility in legs or arms in any way changed? 1 Link to comment Share on other sites More sharing options...
mobey Posted July 31, 2012 Author Share Posted July 31, 2012 Headache? Dizziness? Vommiting? Nausea? Nope Any obvious marks with the neurological examination that could be separated from his ETOH intake? Pupils, etc.? Nope SOB? Thoracic Pain? Nope Any traumatic injury prior? He denies falling, but states he was in a "scuffle" earlier in the night with his scronny friend. Heavvy Lifting? Prior problems with back/spine? Not any more than usual while setting up the carnival rides. First thought says either cerebral problem or propable spinal/nerve thingy, although presentation would be kinda weird with only both arms being affected... Circulation/motivity/sensibility in legs or arms in any way changed? He will absolutly NOT allow you to touch his arms from the elbow down, for pain to even lightest touch. Legs are unremarkable, and he seems to be holding his immense body up just fine with them while standing. Link to comment Share on other sites More sharing options...
Happiness Posted August 1, 2012 Share Posted August 1, 2012 How much does he drink on a daily basis......... Link to comment Share on other sites More sharing options...
cscboulder11 Posted August 1, 2012 Share Posted August 1, 2012 Beyond what I know, but was this at night or day? You said 2 am, then warm summer day. Link to comment Share on other sites More sharing options...
mobey Posted August 1, 2012 Author Share Posted August 1, 2012 Beyond what I know, but was this at night or day? You said 2 am, then warm summer day. Keep me on my toes.... I like it! It was a nice summer day leading up to the middle of the night call He binges once a week, drinking 8-10 drinks. Link to comment Share on other sites More sharing options...
Happiness Posted August 1, 2012 Share Posted August 1, 2012 Well my first road is blocked. So next question What color are the arms, are they flushed or are the pale, and what is his cap refill Link to comment Share on other sites More sharing options...
mobey Posted August 1, 2012 Author Share Posted August 1, 2012 They are pink and dry. From the elbow up they are warm, and he will not let you touch below, however, there is no visual difference between the distal & proximal arm. Link to comment Share on other sites More sharing options...
emtdennis Posted August 1, 2012 Share Posted August 1, 2012 (edited) I don't know why, but a possible stroke (slurred speech) crosses my mind. Could the slurred speech be caused by the ETOH? When was his last drink? Looks like most of the physical vitals are OK, I don't understand, why just from the elbows down. Has this happened to him before? Worst case of tennis elbow I ever heard of. Edited August 1, 2012 by djdudley Link to comment Share on other sites More sharing options...
mobey Posted August 1, 2012 Author Share Posted August 1, 2012 Tennis elbow Hahaha He has been drinking mildly all night. Possible stroke? I'll ask him..... Yup, it is possible! (but not this time) HINT: Consider the pathophysiology of the pain. Link to comment Share on other sites More sharing options...
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