JasonA Posted April 11, 2007 Author Share Posted April 11, 2007 Edit: I was setting her typing this when you posted that message above. So, #1 Possible pneumonia #2 Possible MI #3 Croup or epiglottitis I went back and read over the cases again, and figured out what was making me so confused. I was going through the whole thing and picking out sign/symptoms and trying to figure out what linked them all together. I shouldn't have gotten so distracted by all of the other information and concentrated on each patients Chief Complaint, and then checked the other information to back up my original feeling. I remember that it did say in the book that women, and older men that have MI's present that way. That was my first thought, but like I said, I got so distracted that I never went back and thought more about it. So, as usual, I just need to talk it out and slap myself around a little bit. Thanks for all your time. Link to comment Share on other sites More sharing options...
AZCEP Posted April 11, 2007 Share Posted April 11, 2007 Pnumonia? Would whatever respritory disease you are thinking of account for the rest of her symptoms? PnEumonia is a possibility, but there is one that accounts for all three symptoms you mentioned. Think infectious disease, and a mask (PPE) On #2 my very first though was possible MI. The epistaxis threw me off though, could that just have happened? And have nothing to do with the current issue? Also, isnt his MDI ussages a little excesive, and should that be kept in mind? Tough to elaborate with the information that is presented. The MDI usage isn't really excessive, and we don't know how long he has been dosing that way. After a while, he will become tolerant of the dose, and become less responsive to it. The AMI is a possibility, but again, not enough information to say for sure. He has a significant history for cardiac issues, all of which could contribute. On #3, croup is possible. But would that account for the drooling? 3 y/os dont drool. I not sure where you got the information, but a 3 year old, or a 30 year old will drool when their upper airway is inflamed. Now you just have to figure what is more likely. I am sure that I should have picked it out right off. But my experiance is limited to what I have read in the book, and it has all been thrown at us so quick I am a little overwhelmed. So, Im sorry if it seems like I have no idea, I am just a student, and I really dont. It seems like there are so many things it could be, and especialy with #1, she has so many things wrong. How do you chose what is caused by what, and what the main problem is. Your humility is refreshing, but you have no reason to think you don't know what you are talking about. Some of the best providers, with decades of experience, are known to pick up a book and re-re-re-read sections to make sure they understand it. With scenarios like these, don't read into them too much. It is very easy to trap yourself in the "...if this was happening then this..." game. Take the information, distill it to get the items that are important, and make a decision. At worst you will be wrong, and you will learn more than those that are right with their guesses. Link to comment Share on other sites More sharing options...
JasonA Posted April 11, 2007 Author Share Posted April 11, 2007 Could #1 be TB? We really didn't cover respiratory diseases at all. I don't even remember covering TB, just reading a little about it in the book. The most common cause of ascites, from what I have read, it hepatic(Spelling?) failure. Which is liver failure, right? I kinda passed over that because it is out of our scope of practice, I think. Link to comment Share on other sites More sharing options...
JasonA Posted April 11, 2007 Author Share Posted April 11, 2007 That seems to cover most of case #1, right? Hm...I kinda wish now that we had talked about some of this stuff. The signs of tuberculosis may not appear to be serious at first. They include: * Coughing, which produces a small amount of green or yellow sputum in the morning. As the disease gets worse, the sputum may be streaked with small amounts of blood. * Cold night sweats, which are heavy enough to wake a sleeper up and require a change of nightclothes or bed sheets * Not feeling well in general * A loss of energy and appetite * Weight loss over time * Sudden shortness of breath along with chest pain may be a sign that air or fluid has entered the space between the lungs and the chest wall (pneumothorax). For many people this is the first sign that leads them to seek a diagnosis. * Fatigue * Poor appetite * Fevers that come and go * Sweats * Weight loss in some cases * Pain Link to comment Share on other sites More sharing options...
VentMedic Posted April 11, 2007 Share Posted April 11, 2007 It would be so nice if we could categorize all the ailments in the world into the disease processes that are taught in Paramedic school. Without further diagnostic procedures, it can end up being guess work at best. Trying to "name that disease" can distract one from observing signs and symptoms that may be relevant but doesn't fit with your diagnosis. Link to comment Share on other sites More sharing options...
JasonA Posted April 11, 2007 Author Share Posted April 11, 2007 I couldn't agree more, Vent. A former EMT that I talk to allot has told me a bunch of times to never, ever assume what is going on. Even if you know with out a doubt, always say "Possible......" He always says to manage life threats, and leave the fixing to the doctors. I do see that it helps having atleast an idea of what is possibly going on, or what the person might have. But, this is EMT-B class. The instructor is in charge, and it isn't my place to question her, too much. She wants to know what we think, so thats what I am trying to do. IF it is TB that you are thinking #1 could be, I checked to see what was said about it in our book. It was in the "Protecting Yourself" portion and said that the PT would have a cough, and you needed a mask. That was about it. It didn't even cover it in "Airway" or "Respiratory Emergencies". #1: TB? #2: MI #3: Croup/epiglottitis Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 11, 2007 Share Posted April 11, 2007 Jason can you tell us what EMT book you are using? Link to comment Share on other sites More sharing options...
VentMedic Posted April 11, 2007 Share Posted April 11, 2007 Case 1; I would put more to GI causes. Noc productive cough along with the tea and choc milk could be GERD. Bibasilar rales; chronic aspiration at night. Abdominal pain; bowel obstruction, bladder infection, renal disease (also leads to HTN), acid-base problem and/or electrolyte problems for confusion, cyanosis; pulmonary hypertension or any assortment of V/Q mismatching. But then, I'm going treat the immediate needs first and see how long it takes the hospital doctors to come up with one or more diagnosis. Link to comment Share on other sites More sharing options...
ncmedic309 Posted April 11, 2007 Share Posted April 11, 2007 NCmedic, I am not really sure what you mean. I was attempting to give you the hint - that you need to re-consider your differentials for those three cases - but it seems that your heading in the right direction now... Case 1 TB is highly possible Case 2 Cardiac, Sepsis, Pneumonia - just not enough information to be sure Case 3 Considering the age, cold like signs/symptoms, "high-pitched cough" I would go more towards Croup Link to comment Share on other sites More sharing options...
JasonA Posted April 12, 2007 Author Share Posted April 12, 2007 I was attempting to give you the hint - that you need to re-consider your differentials for those three cases - but it seems that your heading in the right direction now... Case 1 TB is highly possible Case 2 Cardiac, Sepsis, Pneumonia - just not enough information to be sure Case 3 Considering the age, cold like signs/symptoms, "high-pitched cough" I would go more towards Croup Ok. The first time I read it I wasnt sure what you meant, I see now. Thanks for all of your help! Ok, one more question. Doesnt sepsis present with red, hot, and sweaty skin? Also, wouldnt he be coughing if it was pneumonia? Link to comment Share on other sites More sharing options...
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