tniuqs Posted October 22, 2007 Share Posted October 22, 2007 Aortic tear with sub arachnoid bleed...see it all the time Cease all efforts, he is going to die. Get a sheet ready. AK ? aka the Grim Reaper? Well now that we are playing Doctor (and buddy) is in Hospital by now I would hope ? Perhaps fire up tht CT scanner looking for sub dural, sub arachnoid (slower onset in most cases) or AV malformation, but lets hope that patient is just concussed from a coup / contra coup injury. The repeatitive nature of his questions may indicate concussion vs a post ictal state. I dunno, but no sheet just yet :shock: Link to comment Share on other sites More sharing options...
Dustdevil Posted October 22, 2007 Share Posted October 22, 2007 You're fifteen minutes from the trauma centre. Go big or go home. That's why I do bilateral diagnostic subdural burr holes on all AMS patients. If it comes back negative, then go ahead with a BGL. Link to comment Share on other sites More sharing options...
Freaknuggetz_chick Posted October 22, 2007 Share Posted October 22, 2007 ok, so sugars OK. i agree with squint: repetitive questioning sounds like concussion... but you still havent answered my stoke assessment. is there evidence of the car trying to correct/avoid ditch? (looking for evidence that pt was aware of the accident occuring... is the decreased LOC due to accident, or is the accident due to the decreased LOC? and witness stories?). nothing in ECG?? he's dead! hahahahaha where's the sheet AK? what are my vitals?? pt. needs transport, labs and CT at hospital. secondary survey: head-to-toe, ensure patent IV, lung sounds, unilateral weakness check, speech clear so far?, reassess vitals (BP, HR, RR, pupils - which i shoulda specified in primary) Link to comment Share on other sites More sharing options...
ERDoc Posted October 22, 2007 Share Posted October 22, 2007 what are my vitals?? Maybe we should focus on the pt instead? Link to comment Share on other sites More sharing options...
Asysin2leads Posted October 22, 2007 Share Posted October 22, 2007 I'm with Dust. Burr holes all around. I'll go get the cordless drill. Look, if ALS is three minutes away, I think hanging out for three minutes isn't going to make a difference. Then when he starts seizing and choking on his own blood and saliva you won't look so stupid when you pull into the ER making fart noises with the BVM. What's so frustrating about this, anyway? Its called rule out AMS secondary to head injury. Its pretty run of the mill. Link to comment Share on other sites More sharing options...
Dustdevil Posted October 23, 2007 Share Posted October 23, 2007 ROFL@fart noises! And why are fart noises so funny anyhow? They get me every time! Link to comment Share on other sites More sharing options...
Freaknuggetz_chick Posted October 31, 2007 Share Posted October 31, 2007 focusing on pt...head-to-toe trauma exam find anything? would still like some vitals to note if there are any values that are concerning to go with the repitive questioning. O2 tx, iv as per bp, spinal precautions since he is confused and we therefore cannot rule out c-spine.... Link to comment Share on other sites More sharing options...
tniuqs Posted October 31, 2007 Share Posted October 31, 2007 focusing on pt...head-to-toe trauma exam find anything? would still like some vitals to note if there are any values that are concerning to go with the repitive questioning. O2 tx, iv as per bp, spinal precautions since he is confused and we therefore cannot rule out c-spine.... Yea what happened to the original Senario anywhoo? brother dust : its a childhood thang, farts are always funny ... its preceeds the odors, your eating camel again arn't you...whew :shock: ER doc: we are still awaiting Freaknuggetz_chick vitals, I think a GCS of 16 would be something to assume from the get go...... Link to comment Share on other sites More sharing options...
dahlio Posted November 1, 2007 Author Share Posted November 1, 2007 Vitals are around the same as before Repeat B/P 154/92, pulse is 86. Resps. 16. Nothing OUTSTANDING on the 3 lead or 12, but there is something. Head to toe exam reveals nothing except a swollen ankle, which doesn't look recent. Witness states that she saw him pull up to the stop sign, and make a (relatively) full stop, and boom, he was in the woods. Only evidence of him possibly trying to avoid is skid marks, which makes sense since the other car clipped him in th rear. Sorry about the long delay. I stopped getting emails for some reason. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted November 1, 2007 Share Posted November 1, 2007 Despite being oriented x1, will he follow simple commands? Does he have equal grips? GCS? Facial droop? Slurred speech? Oral trauma or other evidence of seizure? Does BLS have O2 sat or BGL? Link to comment Share on other sites More sharing options...
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