Just Plain Ruff Posted April 24, 2006 Share Posted April 24, 2006 I'm thinking dystonic reaction. Lots of the symptoms fit this one. I had a patient who exhibited nearly the same symptoms a long time ago and found that they had taken some of Grandma's nerve pills. Link to comment Share on other sites More sharing options...
JPINFV Posted April 24, 2006 Share Posted April 24, 2006 A pulse ox could probably have given you a quick assessment of the subjective cp. (Assuming that the patient isn't acting) Probably not, actually. Just because the heart is hypoxic (secondary to a coronary blockage, for example), doesn't automatically mean that the person has a problem with O2 saturation, especially early on. Based on the patient skin signs and BP (sure, its elevated, but really not that much), the patient doesn't appear to have problem pumping blood. Breath sounds are clear and equal, along with no medical hx (i.e. lung cancer, COPD, pulmonary HTN), so it appears that both lungs are functioning quite well. SOB most likely secondary to anxiety or localized hypoxia. From a BLS prospective, it looks like it might be a CVA or possibly an MI (grant it, skins are great for an MI and the neuro problems are more associated with CVA). Both of these are localized hypoxic event. Both of these would, except when stroke volume starts to decrease during an MI, have a great spO2 since cardiac output is higher (for the non-medics out there, cardiac output=heart rate x stroke volume [the amount the heart contracts]). Both of these patients get high flow O2 so that if any blood gets past the clot it will be fully oxygenated. O2 also carries the placebo effect. "Well, they're doing something for me [high flow O2], so I should start to feel better..." They feel better, the anxiety level decreases. Parasympathetic nervous system kicks in lowering the heart and breathing rate. This lowers the demand for O2 (less ATP used up...) and saves muscle. A low spO2 is helpful. A normal spO2 doesn't really rule very much out, though. Link to comment Share on other sites More sharing options...
Katiebug Posted April 24, 2006 Share Posted April 24, 2006 So was it a panic attack, TIA, ACT or what? Ever do the follow up? Link to comment Share on other sites More sharing options...
medik8 Posted April 24, 2006 Author Share Posted April 24, 2006 Sorry guys...I apologize...I haven't been on all weekend and didn't realize this got brought up again.... :oops: I DID check with this patient... There were two more episodes of the exact same situation...both of which corrected themselves. As of the last time we spoke, they were conducting various tests. No explanation whatsoever at this point in time. Has to be one of the strangest things I've seen though, just due to the presentation and all. If I ever find out what this was...i will be sure to let you know. I had my doubts at first...but I actually do NOT believe that this was an attention episode at all. I've gotten to know a lot more about this patient, and that does not seem the case at all. P.S. His arm did smack him in the face... xoxoxo :wink: 8 Link to comment Share on other sites More sharing options...
Callthemedic Posted April 25, 2006 Share Posted April 25, 2006 (Assuming that the patient isn't acting) Probably not, actually. Just because the heart is hypoxic (secondary to a coronary blockage, for example), doesn't automatically mean that the person has a problem with O2 saturation, especially early on. Based on the patient skin signs and BP (sure, its elevated, but really not that much), the patient doesn't appear to have problem pumping blood. Breath sounds are clear and equal, along with no medical hx (i.e. lung cancer, COPD, pulmonary HTN), so it appears that both lungs are functioning quite well. SOB most likely secondary to anxiety or localized hypoxia. From a BLS prospective, it looks like it might be a CVA or possibly an MI (grant it, skins are great for an MI and the neuro problems are more associated with CVA). Both of these are localized hypoxic event. Both of these would, except when stroke volume starts to decrease during an MI, have a great spO2 since cardiac output is higher (for the non-medics out there, cardiac output=heart rate x stroke volume [the amount the heart contracts]). Both of these patients get high flow O2 so that if any blood gets past the clot it will be fully oxygenated. O2 also carries the placebo effect. "Well, they're doing something for me [high flow O2], so I should start to feel better..." They feel better, the anxiety level decreases. Parasympathetic nervous system kicks in lowering the heart and breathing rate. This lowers the demand for O2 (less ATP used up...) and saves muscle. A low spO2 is helpful. A normal spO2 doesn't really rule very much out, though. I'm thinkng about what the source of angina is. If the CP is cardiac, the pump is not functioning properly. SOB is second to pain, anxiety in angina. Increase in BP might indicate compensation. A RA sat is needed for assessment. It should start dropping the second you take the 02 off. If they are DQ, they would have to hold thier breath for awhile to get the sat to drop. Link to comment Share on other sites More sharing options...
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