He's having a stroke!!!

[ERDoc]

You are called to a restaurant for a possible stroke. You arrive to find a 32y/o male c/o tingling around his mouth and in his tounge. He didn't think anything of it at first but started getting concerned when his hands were going numb and he seemed to have trouble picking things up. For those that will ask, yes the scene is safe.

[Just Plain Ruff]

What did he eat?

What Kind of restaurant are we eating at?

did he have anything made with Pufferfish?

Any food with Cayenne or Habanero peppers

[EmergencyMedicalTigger]

What does he look like? Equal grips? Speech ok? How is he breathing?

[Andrewtx]

Any known allergies?

Has he ever experienced anything similar?

In addition to what did he eat, what was he doing before he ate, specifically did he handle any unusual substances or materials, and did he wash his hands before eating?

How does he describe the numbness in his hands? Did it start in his fingertips and progress proximally? Can he move his toes normally and is there any similar sensation?

[Eydawn]

BP, R, P? If he's hyperventilating, he could have the mouth/hand numbness and the hand contractions that go along with it in severe cases... maybe worried about proposing to someone, lol?

Agreed with the question about allergies, occupation, meds, what he was doing immediately prior to the meal and what he's been eating drinking recently. What's his orientation status? General appearance? Pupils? Family HX? Numbness anywhere else?

That'll do for starters.

Wendy

CO EMT-B

MI EMT-B

[chbare]

What my general impression of the patient?

Is he wake and responsive?

Is his airway patent. Any stridor or evidence of angioedema?

Is he breathing without difficulty. Any new onset skin lesions or rash?

Heart rate and quality along with a set of baseline vital signs and a blood sugar?

SAMPLE history as per above.

Take care,

chbare.

[ERDoc]

The restaurant is Honshu Sushi. The pt is not sure what he ate. It is a dinner function for his job and the boss did the ordering. He looks well, just worried. He tells you, "Help me, I think I'm having a stroke! I'm too young to die!" Speech is OK and there is no stridor or other abnormal breath sounds. He is breathing a little fast (24-28 per min), but it could be from his anxiety. HR is 110 and BP is 138/90, SaO2 is 100% on room air. Grips are equal, but weak bilat. He has no known allergies and has never had anything like this before, however he has never eaten Japanese before. He has no handled any unusual substances. He describes the feeling in his hands as a tingling and weakness to the point that he was having trouble picking up his chop sticks. He is beginning to develop a similar sensation in his toes. He says that it seemed to start in his finger tips and has been progressing more proximally. No carpopedal spasms. He was not going to propose to anyone. As for his orientation, he insists he is straight despite his "I love Becksdad" tattoo on his lower back. He works for a computer company in the programming department. No family history. PERRLA at 4mm (seems appropriate for the ambient lighting). He is awake and alert. His ariway is patent and there is no swelling/angioedema. No rash and FS is 110. Your partner looks at the table and says that there is Sake and some stuff that looks like different kinds of fish (being the uncultured brute he is he does not know what kinds of fish). The restaurant owner comes out and says to you that you need to get out as quickly as possible as they have a new chef and you are making him and the other guests nervous. What do you want to know now and what is your next move?

[Just Plain Ruff]

Holy godiva chocolate batman, this guy could be in real trouble, and I'm not joking on this, especially if the chef didn't know what he was doing.

[AnthonyM83]

I would tell the staff we won't be able to leave until we find out exactly what was ordered and what he ate, and if we stay much longer things could get worse and it'd be worse for the company's reputation. Could the new chef have screwed up the preparation of a poisonous fish? Ask to speak to the manager immediately and get him to interrogate the employees.

Any actual pain/pressure, orthostatic vitals?, full field neuro assessment, base would probably tell us 12-lead.

If that's not getting you anywhere, get a sample of what he ate and start transport, in case it gets worse.

[EMS-Cat]

Puffer fish is now #1 on my hit parade. Either raw or in a soup. I'm not discounting other options, but we've got an otherwise healthy, adult male presenting at an Asian Restaurant with a new chef [and a *very* freaked out owner] c/o numbness & tingeling in lips and fingers but has equal bilat grip, a feeling of impending doom, etc after eating a meal of unknown items and ingredients.

Not going to go into the whole bit on Puffer, but the wiki entry on it have a good over-view.

Wiki - Puffer Fish

Basically, it's a nasty Na+ channel blocker.

And before anyone gets upset, yes, I'll be doing all the regular stuff: vitals, SAMPLE, support ABCs, etc. But the 1st r/o in my head will be 'tetrodotoxin ingestion', followed by allergic reaction, followed by atypical CVA/TIA, etc.

I live in an area with a fairly high Pacific Rim population base - we see it out here every now and then.

BTW: anyone here ever watch 'The Simpsons'? :wink:

"One Fish, Two Fish, Blowfish, Blue Fish"