medik8 Posted February 20, 2006 Share Posted February 20, 2006 Ok...everyone...here's my strange call of the night. I am very interested in everyone's inputs/ideas as to what they think may have been going on here. I have a few ideas...but would like your input just for grins... Get called out for a 19 yo Male, chest pain, SOB. Upon arrival, pt. is lying on the floor, appears in distress, working at breathing. Vitals as follows: BP 148/86, P 104, R 36. Monitor shows a normal sinus tach. Color is normal, no diaphoresis, skin is warm and dry. Lungs are clear, abdomen soft, PERRL. Patient is A/O X 3. Patient states he has chest pain that he rates at a 10. Patient is completely flaccid on the left, no grip strength, cannot push with his foot, and denies sensation, appears to be no reflexes, but can wiggle toes on command. Pulses are good. There is no history of any trauma. There is no past medical history at all. Patient has been with friends a short time, but denies alcohol/drug use. Denies the possibility of anyone giving him anything without his knowledge. Family has had a small argument, but nothing out of ordinary. Patient suddenly begins to tremor, is slightly drooling out of left side of mouth, tongue drops out of mouth and hangs there, and he becomes more anxious. Still completely responsive and can answer questions with a little difficulty. No LOC. No seizure activity. No asymmetry to face. Blood sugar checks a little low at 86. No allergies/no meds. After a while, chest pain drops to a 3 and then subsides completely. What do YOU think.....?? Link to comment Share on other sites More sharing options...
JakeEMTP Posted February 20, 2006 Share Posted February 20, 2006 In my short career, this doesn't make sense to me. But I'm just guessing. I think he's full of it IMHO. I hope you started bi-lateral 14g on him 8! lmao :wink: Link to comment Share on other sites More sharing options...
Guest Posted February 20, 2006 Share Posted February 20, 2006 Firstly Is this BLS call? Unless there is some trick here, that I am missing it sounds fairly straight forward. Your painting a picture of CVA, uncommon but not unheard of in a 19 yr old, this would be a conservative primary working DX. Standard protocols O2, Line, monitor and time to get the heck out of Dodge......notification patch enroute, no delay in transport to a stroke center as it can be a tight window for thromboliytics. No reflexes...deep tendon? But can wiggle his toes to command...wierd. Chest pain Suddenly disappears...very odd. No recreational Drug use is suspected? Will follow this one but your avatar makes me dizzy. :shaking: Link to comment Share on other sites More sharing options...
medik8 Posted February 20, 2006 Author Share Posted February 20, 2006 Sorry about the avatar, squint....I haven't found one I like...lmao NO, this is not BLS....I do not have a BLS truck.... :shock: That's right...chest pain disappeared... I suspected poss. drug use...patient denies, and seems fairly believable. I considered MI...at first...then CVA.....but.... I'll let a few more post first... Link to comment Share on other sites More sharing options...
Dustdevil Posted February 20, 2006 Share Posted February 20, 2006 Was he effeminate? Link to comment Share on other sites More sharing options...
medik8 Posted February 20, 2006 Author Share Posted February 20, 2006 LMAO No, I didn't get that impression...but one would suspect. I agree...under the circumstances... *DRAMA*.. :roll: Link to comment Share on other sites More sharing options...
benanzo Posted February 20, 2006 Share Posted February 20, 2006 ok, was he supine when his tongue dropped out of his mouth and hung there? that might require some effort on his part. Link to comment Share on other sites More sharing options...
medik8 Posted February 20, 2006 Author Share Posted February 20, 2006 :roll: uh....yeah.... Link to comment Share on other sites More sharing options...
MedicNorth Posted February 20, 2006 Share Posted February 20, 2006 was he from nebraska? Link to comment Share on other sites More sharing options...
xselerate Posted February 20, 2006 Share Posted February 20, 2006 The symptoms you are describing strike me as extreamly odd and as such make me wonder if perhaps there was more than one thing going on here. Maybe ( however unlikely ) he was having both a cva and mi. Maybe he was having a thoracic aa ( although i doubt it... but I'm willing to consider anything ). Well anyway... think about multiple seperate causes if no one thing fits everything. Link to comment Share on other sites More sharing options...
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