AZCEP Posted July 20, 2006 Share Posted July 20, 2006 Wind: the pulmonary system is the primary source of fever in the first 48 hours. Wound: there might be an infection at the surgical site. Water: check intravenous access site for signs of phlebitis. Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue. Whiz: a urinary tract infection is possible if urinary catheterization was required Wonder drugs: drug fevers. Link to comment Share on other sites More sharing options...
chbare Posted July 20, 2006 Share Posted July 20, 2006 AZCEP, Nice, I like the "Wonder Drugs" part as well. Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted July 20, 2006 Share Posted July 20, 2006 Amazing what a couple minutes in a dark room with Google can get you, eh? Link to comment Share on other sites More sharing options...
medic53226 Posted July 21, 2006 Author Share Posted July 21, 2006 Pt remains combative as you leave family says ammonia level was elevated last check 1-2 days, and that is was just sleeping and they heard he start snoring and no can seem to find her meds, This is als unit, and np is nasal airway, pt had 98% on NRB @ 15 Lpm, unable to get glucose, monitor was dropped actually the pt threw the glucose monitor as it was getting setup to check a sugar, pt would be combative for a few seconds - mins stop posture and then without notice become combative again it seemed only stronger. I have me a paramedic, my partener emtb and FD driver. Pt snoring has decreased a little with the NP airway, but still has the snoring. Pt pupils are sluggish to light, but equal, BP is now 148/68, per partner. Pt still has good lung sounds. We are not able to get a temp. No guarding when abd checked and the surgery site has just minor brusing, no obvious signs of infection and whole body is hot. What else Link to comment Share on other sites More sharing options...
AZCEP Posted July 21, 2006 Share Posted July 21, 2006 No guarding when abd checked and the surgery site has just minor brusing, no obvious signs of infection and whole body is hot. You've just contradicted yourself. Maintain blood pressure, sedate--possibly RSI, secure an airway. Any strange odors coming from the patient? Acetone, ammonia, almonds, etc.? Might try some Thiamine while thinking of something else. Have we got lab values available? Consider some Narcan, if the history suggests some narcotic use since the surgery. Could this be an anti-cholinergic toxidrome? Need to find out what medications she was put on after the procedure. Link to comment Share on other sites More sharing options...
MrSpykes Posted July 21, 2006 Share Posted July 21, 2006 I would definitely RSI, her resps are snoring, she is combative, her GCS is low, she may have a stroke or other bleed in her head, maybe she through a clot from surgery. We really cant find the problem and we need to take control of her airway at this point. I almost want to say try and give 12.5 of D50 but if it is a head bleed then we don't want it necrosing the brain. I don't think the Narcan will do much because opiates would sedate her and not make her posture and be combative. I would probably just RSI and get to rolling hot to the hospital. Continue monitoring pt and ventilating about 15/min. Link to comment Share on other sites More sharing options...
medic53226 Posted July 21, 2006 Author Share Posted July 21, 2006 AZCEP, I'm not following you when you say I contraindicated by self, about the abd, when pressure is applied she dosen't respond to the area, dosent grab you had or try to guard her abd. The surgery site is by the RUQ, we have to call for RSI, and our MC refused RSI, pt remains combative and a BS is finally achieved, and reading is 21, pt is given D50 25 grams IV that was started in the EJ 18 ga, pt responds within mins and becomes AOX3 enroute to the hospital. Ok this is the first time I got a pt with temp and low bgl, they are usually cool, clammy, sweaty, and have had some seizures with the hypotension. I wrote to see what everyone else would do. Because this was a actual run just a few days ago at our service. Link to comment Share on other sites More sharing options...
AZCEP Posted July 21, 2006 Share Posted July 21, 2006 No, no, no, my comment was directed at the "no signs of infection, body is hot." Temp means infection until proven otherwise. Link to comment Share on other sites More sharing options...
chbare Posted July 21, 2006 Share Posted July 21, 2006 AZCEP, I agree. If she stabilizes with the IV Dextrose, we need to find out why she has a temp if possible. This sounds like more than a hypoglycemic episode. (other stuff going on) Look at the 5 W's and rule out medications. (Haldol, Thorazine, etc.) Medic53226, were you able to get a follow up on her? Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted July 21, 2006 Share Posted July 21, 2006 The hypoglycemia could very well have been a response to the infection. Hyperdynamic-->hypodynamic state progression. As the body uses up it's fuel, sugar, the temp will progressively lessen. Very bad when it happens, but I've seen septic patients with all color of oozing substances without fever. Excuse me while I go shower. I suddenly feel very dirty. :oops: Link to comment Share on other sites More sharing options...
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