Just Plain Ruff Posted October 15, 2007 Share Posted October 15, 2007 39 year old male. Wife called due to patient having consistent and chronic headaches over the past 3 weeks. Pt. complains that he just doesn't feel right. Sort of feels disconnected from the world. Have at it. Link to comment Share on other sites More sharing options...
spenac Posted October 15, 2007 Share Posted October 15, 2007 I know nagging wife syndrome. HX of event HX medical/medicines Vitals = BP, pulse, BGL, pulseox, EKG, etc Any stroke s/s Cincinnati exam, motor function, facial drop etc That will be a start Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 15, 2007 Author Share Posted October 15, 2007 HX of event - gradual onset of headaches every other day over a period of about 2 months and then chronic headaches for the last 3 weeks straight. Basically been in bed each weekend to get rid of the headaches HX medical/medicines - No medications except for Excedrin 3 pills every 4 hours daily for 2 weeks Vitals = BP, pulse, BGL, pulseox, EKG, etc BP 128/90, Pulse - 100 BGL - 145 Pulseox - 99 on room air EKG - Normal sinus rhythm, 12 lead shows the same (hence no cardiac problems noted on EKG What's the ETC??? Any stroke s/s Cincinnati exam, motor function, facial drop etc - NOPE nothing out of the ordinary. Link to comment Share on other sites More sharing options...
EMS Solutions Posted October 15, 2007 Share Posted October 15, 2007 On/off X 2 months, constant x 3 weeks? Did he go to his primary MD yet? Or is he using 911 as his PMD? What makes this episode different that required calling 911? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 15, 2007 Author Share Posted October 15, 2007 nothing different except that his nagging wife told him he either gets his sorry butt up off the bed and into the car and to the doctors appointment they have (he didn't want to go to the doc's) or she was gonna call 911 Well she called 911 Link to comment Share on other sites More sharing options...
rocket Posted October 15, 2007 Share Posted October 15, 2007 So what's new in his life? New foods, new habits, changes to living arrangements lately? How does the residence look when we arrive? Any evidence of an environmental change (i.e., recent construction to home, etc)? How about an old trauma (sure we'll go back as far as a few months). BTW what does this guy do for a living? Perhaps in the privacy of the rig we could ask if he's had any recreational substances lately that the wife may not be privy to. Is he suffering from one of these headaches when we arrive? if so what is his behavior like? is he photophobic? Having any problems with neck stiffness, etc? Anything interesting in the family medical history? -Trevor Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 15, 2007 Author Share Posted October 15, 2007 So what's new in his life? The headaches nothing really different. Complains of slight hand tremors but feels that the tremors are a recurrence of his Essential tremors diagnosed about 10 years ago. He took Propranolol for those but has not taken any propranolol for over 8 years New foods, new habits, changes to living arrangements lately? How does the residence look when we arrive? Any evidence of an environmental change (i.e., recent construction to home, etc)? How about an old trauma (sure we'll go back as far as a few months). BTW what does this guy do for a living? -- No new foods No new habits No changes to living arrangements Residence is very well kept no construction No old trauma He's a IT consultant and travels to jacksonville florida every week monday thru thursday and is at home friday sat and sun Perhaps in the privacy of the rig we could ask if he's had any recreational substances lately that the wife may not be privy to. No recreational substances whatsoever Is he suffering from one of these headaches when we arrive? if so what is his behavior like? is he photophobic? Having any problems with neck stiffness, etc? The headache is there when you arrive. No photsensitivity. No stiff neck Anything interesting in the family medical history? Nothing in the medical history - just a grandma who had type 2 DM. By the way, this guy is me and I wanted to give this scenario because I think it will be a good learning tool. Link to comment Share on other sites More sharing options...
captainstandup Posted October 15, 2007 Share Posted October 15, 2007 Field management is simple, treat the symptoms, guard the airway,IV, O2 (but that will change in the near future with all the free radical data coming to light) be prepared to treat seizures, analgesia for extreme pain and zofran or promethazine IV if you are nauseated. You need a CT now to rule out lesion and CVA. Although you said no to neck stiffness I wouldn't rule out encephalitis. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 15, 2007 Author Share Posted October 15, 2007 Ok you do all that and transport to the hospital. Full ER workup done. Elevated Hemoglobin A1C Patient tells wife she over-reacted (ha ha) Patient decides to appease wife and see's family doc. He orders a fasting glucose and a repeat Hemoglobin a1c fasting glucose - 181 Hemoglobin a1c - 6.8 Anyone want to chime in on the diag? Link to comment Share on other sites More sharing options...
parabrandi Posted October 15, 2007 Share Posted October 15, 2007 after reading the questions and answers so far, i'd like to take a stab at this one an say "left sided cystic lesions". my 12 year old son had the same thing almost to a T and we had 3 MRI's and a CT and the conclusion was ..... The cysts had always been there and with differing degrees of pressure inside each cysts came the symptoms...feeling funny, headaches, sensitivity to sound and sometimes mild vertigo. Well there's my 2 cents...by the way, this condition is not treatable...just gotta' roll with it. Link to comment Share on other sites More sharing options...
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