Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 (edited) He admits to being very depressed. Denies any suicidal thoughts. He also says he hasn't been able to walk without holding on to things as he's very weak. He admits to this being unusual for him, he is normally pretty healthy. He looks sick. He's almost white in color, when you assist him in standing, he leans heavily on you and your partner, his gait is very unsteady. He is willing to come with us to the hospital. Is there any other vital you'd like to check? Edited October 19, 2012 by Curiosity Link to comment Share on other sites More sharing options...
Arctickat Posted October 19, 2012 Share Posted October 19, 2012 Pericarditis!!! Link to comment Share on other sites More sharing options...
Kaisu Posted October 19, 2012 Share Posted October 19, 2012 Im concerned about the bradycardia. What's his O2 sat? MAP? Flattened affect is common in severe depression. But I think he's sick and I'm thinking beta blocker OD.... Link to comment Share on other sites More sharing options...
Arctickat Posted October 19, 2012 Share Posted October 19, 2012 Ok, seriously, what is his hemoglobin reading? How old is he? Until your last post I was starting to lean toward early onset Alzheimers which would include some memory loss and lethargy...basically a lack of initiative to do anything which could be confused with depression. Especially if it's a mixed dementia. Given his cardiovascular history it is a possibility that he had vascular dementia as well. A few well placed questions and interrogation would help to identify this. Asking him to identify things such as his friends or items in the house would help. Also, asking him to remember three things, then recall those three things later on would help to assess his memory. Now, following your last post I am interested to see if there is any anemia occurring. Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 (edited) I don't have hemoglobin level, we're still in his house. He's alert, oriented, answers questions properly although a little slowly. I'm sorry, I didn't mention age...he's in his early 60ies. Neuro exam is clear, weakness is noted bilaterally in his arms and legs but grip strength is equal. His O2 sats are 100% on room air, Had to try different fingers with the sat monitor before we got a reading. MAP 73. He states he's been taking his meds as prescribed and the count on the bottle doesn't suggest he's taken more. Did I miss any other vitals? Edit to include extra info about sat Edited October 19, 2012 by Curiosity Link to comment Share on other sites More sharing options...
emtdennis Posted October 19, 2012 Share Posted October 19, 2012 Have to go with the need for a good physical, which would most likely include extensive bloodwork. In my limited experience, it looks like you have done what you can do in the field. I am looking to learn from this also. Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 Sorry, edited above about the difficulty of getting a sat reading. Had to try a few times to get a number. Link to comment Share on other sites More sharing options...
Arctickat Posted October 19, 2012 Share Posted October 19, 2012 I think that every ambulance should have one of these... http://www.cliawaived.com/cf.inventory.htm?action=showinvone&invid=1942 Then again, I also think that every ambulance should have one of these too... http://www.jbodenmann.com/american/cowcatcher.jpg Any N/V, when was his last BM and what did it look like? I'm leaning toward GI Bleed in case you haven't noticed. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2012 Share Posted October 19, 2012 We need to do a set of orthostats. I do find those helpful in GI Bleeds. He's also amicable in going with us to the ER so let's stop talking in the house and put him on the cot and go. Start an IV, transport and talk to him some more. He might be more open with us out of earshot of his friends if he's a proud person. What happens if we stand him up? Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 You and your partner stand him up. He's unable to stand on his own, states his legs are really week. It takes the two of you just to hold him upright. Because of this, orthostatic pressure is difficult to do. (I didn't do one of those, but had I, it wouldn't have given you anything.) Last BM in the AM, patient states he did no notice any blood. No N/V. Captain, you load him up and attempt an IV. You find access after much difficulty and get very little flash from it. Any other vitals while in rout? I think that every ambulance should have one of these... http://www.cliawaived.com/cf.inventory.htm?action=showinvone&invid=1942 Then again, I also think that every ambulance should have one of these too... http://www.jbodenmann.com/american/cowcatcher.jpg I love the Hgb meter but I'll be honest, until I starting on these forums, I couldn't tell you what the proper readings were. There isn't a big importance placed on that in my course Link to comment Share on other sites More sharing options...
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