AZCEP Posted April 12, 2007 Share Posted April 12, 2007 DISCLAIMER: Only based on the information provided, and could be wildly wrong. #1: Spot on with the Tb. At least that's what it sounds like from here. #2: I'm guessing right sided heart failure. Although, why your instructor would focus on this is truly beyond me. #3: Definitely epiglottitis. Croup is caused by a bacterial infection, and epiglottitis is viral. This child had a cold, which is usually viral as well. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 12, 2007 Share Posted April 12, 2007 I'm a little dismayed that the instructor is presenting these types of scenarios. Jason I'm still curious as to what your book is that you are using? Link to comment Share on other sites More sharing options...
AZCEP Posted April 12, 2007 Share Posted April 12, 2007 I won't go so far as to say dismayed, but these scenarios really don't fit with what you should be focusing on. It's great that you are being challenged to differentiate between disease states that cause medical students fits, but I'm not sure that's the most useful way to spend your time. I am also curious about which textbook you are using. I fear that the lack of information that it is giving you is widespread, and not isolated to one publisher. I'm beginning to understand why some don't want EMT's handling emergency traffic. :shock: Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 12, 2007 Share Posted April 12, 2007 well the reason I say dismayed is that obviously this good student has not been prepared for the questions that were posed on the scenarios. he specifically stated that the respiratory component of his education was very very short. That is why I say dismayed, it's upsetting that this instructor, according to what I can read from this young student Jason, has not prepared her students for those types of questions. It makes me wonder if he has a book at all or is the instructor using handouts like some of my college instructors did when they didn't like any of the current texts out there. Jason, what book are you all using. Link to comment Share on other sites More sharing options...
JasonA Posted April 12, 2007 Author Share Posted April 12, 2007 We are using: Emergency Care and Transport of the Sick and Injured Jones ane Bartlett Publishers There website for the book is www.EMTB.com This is the first time we have ever done something like this. Generally out scenarios are more simple, and try and get us into assessing, not so much diagnostic. Could you guys give me an idea of what you think would be the most important things to cover, so atleast I can be working on it on my own? Edit: I checked again, and there is only that one little thing about TB. I will admit that #2 was just me making things to complicated, the first thing I thought of was MI. I just moved on and got confuzzled. Link to comment Share on other sites More sharing options...
VentMedic Posted April 12, 2007 Share Posted April 12, 2007 Okay, after re-reading the wording of the instructor, I'm taking a new angle. The question in perspective: "What is his/her condition and what is your treatment?" I would take this to be a chance for the EMT-B to identify different levels of urgency and plan supportive care/treatment and/or need to have ALS if long transport or immediately nearby. A lot of info but do we have our ABCs intact and maintainable? Is there a chance of immediate deterioration based on your assessment? JasonA, I like your concern for oxygenation in all of your treatments. Case 3; Epiglottitis can be caused by Haemophilus influenzae type B. This is also contagious and no picnic for an adult either. Luckily there is the Hib vaccine. Keep this kid "content" during transport by all means. Blowby O2 will be fine if the child shows signs of being annoyed by the looks of a mask. Link to comment Share on other sites More sharing options...
CBEMT Posted April 12, 2007 Share Posted April 12, 2007 #2 sounds a lot more like CHF (which may or may not be secondary to an MI) than #1, at least to me. Respiratory distress, edema, higher daily dose of Lasix, skin signs, etc. Link to comment Share on other sites More sharing options...
ncmedic309 Posted April 12, 2007 Share Posted April 12, 2007 You respond to a 3 y.o. female who’s mother is complaining of dyspnea accompanied by a harsh high-pitched cough. You patient assessment reveals that she appears sick is tachypneic at 38/min, tachycardic at 118/min normal blood pressure, is running a fever of 102 degrees has a cough and is drooling and is pale and has cyanotic lips. She is also congested and has signs and symptoms of a cold. You could easily argue Croup vs Epiglottitis with this presentation. Just to clarify a few things about the two... * The patient's age - croup is quite common between 6 months and 3 years of age * Croup is typically caused by a respiratory virus, the most common being the parainfluenza virus. * Usual history of cold-like signs and symptoms * Increased RR - Increased HR - elevated temperature (usually less than 102.2F) * Harsh-high pitched cough (seal-like bark) Epiglottitis is a bacterial infection, usually caused by the haemophilus influenzae type B. However, it's becoming less common due to a vaccination for HiB. The age group typically infected is 4-7 years of age. Unlike croup - the epiglottitis patient is quiet and doesn't make much noise unless the airway is extremely narrowed causing stridor. The absence of cough in this patient and a much higher fever (> 103F) would make me lean more towards epiglottitis. The onset of epiglottitis is also much quicker and doesn't typically present with cold-like signs and symptoms. Given the above scenario - I would go with Croup all day long on this one... Link to comment Share on other sites More sharing options...
VentMedic Posted April 12, 2007 Share Posted April 12, 2007 Possibly, but if treating this pt at the EMT-B level, I would rather error on the side of caution until I am in the hospital setting. Again when you make a diagnosis without all the diagnostic tools or much higher initials behind your name, it comes to educated guessing. Link to comment Share on other sites More sharing options...
AZCEP Posted April 12, 2007 Share Posted April 12, 2007 Might want to check that again ncmedic309. Epiglottitis is viral, croup is bacterial. The similarities between them make field diagnosis a bit of straw drawing. We have to go with the information that is in the scenario for our best "guess". We would assume the child had received the HiB vaccine, but there is no information that says so. Harsh cough with drooling, could be either. Previous cold, leads to a suggestion of viral involvement. Being in the information gathering business, there isn't enough here to satisfy what we want to know. As for what you should spend time on, your treatment options are limited by the basic scope of practice. Patient positioning, appropriate oxygen administration, recognition of a potentially unstable patient, and transport are what you need to become comfortable with. It sounds like you are well on your way. Link to comment Share on other sites More sharing options...
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