ERDoc Posted June 1, 2006 Share Posted June 1, 2006 Pt has no good veins, IV attemps x3 enroute failed. Why bgl? We didn't take one. No indications for it as far as I can see. ECG 12 lead shows 1st degree HB, otherwise nomal. Prob. not sepsis- no recent hx of any signs/symptoms of infection. BP in legs- L 90 sys, R 130 sys (or vise versa, I don't remember). Micturation syncope?....lasting approx 5 hours? I dunno, you're the doc. Any more ideas? Mictruition syncope can last quite a while from what one of our cardiolosists have said, but I didn't realize that it had been 5 hours so you are right not likely. Do not rule out sepsis in this case. Elderly people are not up on the latest textbooks, so they don't know how to present with typical symptoms. Though I think it is low on the ddx (especially with those BPs in the legs), don't take it off just yet. Let's get cultures. I think we need to continue trying to get IV access, when you get to the ER we'll drop a central line in. Link to comment Share on other sites More sharing options...
chbare Posted June 1, 2006 Share Posted June 1, 2006 Hammerpcp, I have had a few bad experiences with sycopal episodes and low BGL's, I admit I am a little overzealous about BGL's, but we all cannot be without vices. Did anybody try for an EJ? do we have IO access as an option If she crashes while attempting EJ access? Too bad we could not do a quick US and look for fluid/aneurysm. Sorry, I overlooked the no pulsating masses part of your assessment, typical nurse not listening to the medic. Take care, chbare. Link to comment Share on other sites More sharing options...
medic53226 Posted June 1, 2006 Share Posted June 1, 2006 I had a pt had a BGL of 33, and to my awe, she was alert, could answer my questions, but she was cool, clammy, dizzy to the point she could walk the 2-3 steps to the cot, but, by the time I got the IV which was like looking for needle in a hay stack. I to as most that read this are saying equipment problem, I check it that moring and again after the run and it said that it was ok, so I would have got a BGL just to have one because our Doctor hear says if you are doing a IV it dosen't hurt, and I still think you will find that it is diverticulitis, but what everyone else said are just as problem the problem as is what I think. Nothing againist the anyone else. Did you get a last meal on this pt to find out if maybe it could be food posioning maybe just a thought. Link to comment Share on other sites More sharing options...
hammerpcp Posted June 2, 2006 Author Share Posted June 2, 2006 I had a pt had a BGL of 33, Did you get a last meal on this pt to find out if maybe it could be food posioning maybe just a thought. Geez she's got hyperglycemia! :wink: As far as last meal....no, I didn't ask. She was not having any vomiting or diarrhea so I wasn't thinking food poisoning. She did say that she was eating and drinking usual amounts though. I am pretty sure she wasn't pregnant, but I recently learned that you never know. Me to pt: "When was your last period?" Pt replies " 20 years ago". :shock: Definetly ruptured ectopic pregnancy. Link to comment Share on other sites More sharing options...
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