ERDoc

Hmm...Interesting thought. What could possibly lead to metformin causing lactic acidosis? Chbare, I think my wife might object also. Sorry.

So far I am not impressed with this hospital. How about a Foley? Did they at least check a chem 7. EMSGeek, when we talk about white counts, we generally leave off the thousands and just say something like 12.4 instead of 12,400. So, a nl WBC is 5-10. PS-This is my 1000th post! I have become a senior. Anyone want to go to the prom with me?

I'd refuse transport as I have a sick pt with no information. This is a setup for badness. I realize that this is just a scenario so we'll play along. Since we have the chart, let's thumb through and see what has been done. Maybe that will help us figure out what is going on.

I'd like to take report from the hospital to find out what's going on, or at least their opinion of what's going on.

Having grown up a couple of miles from where this happened, I can tell you there is a good chance that this was a volley. LI is one of the largest volley systems in the world. Yup, there are many whackers or as they are called there, buffs.

Yes, this is indeed a TCA overdose. What about the EKG is almost pathopneumonic for a TCA overdose?

OK, can't let it go. You've talked about licks and nits in you last few posts. We seriously need to talk. No harm intended Sdowler, just thought it was funny.

Dude, if you are picking nits, you have much bigger problems than this lady's gag reflex. PM me and we'll set you up an appointment for treatment. :wink:

When you are a resident, you work so much and are so tired that you have no use of it anyway, might as well have ED.

There are no alcohol bottles laying around. She does not smell like she has been drinking. The son tells you she does not drink. Here is your 12-lead.

The son does not beleive she has ever eaten Fugu and then questions your competence. This is happening in the spring and it has been nice (no need for heat).

The son tells you that she keeps her sugar under good control because she does not like the way she feels when it is high.

The son is not sure where she has her pills, but he will look for them. We don't see any so far. Temp is 101.8 (yup this was rectal). It is safe to assume that this is not CO, but if you want we will have the FD check and they will confirm that this is not the case.

Your aggressive service allows you to do H&Hs. Hers is 14.5 and 44.2

No other pts. Lung sounds are rhonchorus diffusely. Skin is very warm to touch with dry skin, color is normal. No one else is feeling ill and there are no odors. Head to toe reveals no deformities, bruising, rashes. RTA? Are people thinking Renal Tubular Acidosis based on what we have so far?

Nope.

Scene is a 1 story house. She is in the hallway as previously described. There are no ladders, stairs or stepstools. Carotid pulses are present. Not sure what you mean by II (I'll defer to Dust for points deduction). Son says she has no allergies. No recent med changes. Son said she was eating breakfast when he left this morning. The son thinks she has been feeling down lately but nothing serious. Pupils are dilated to 8mm and minimally reactive. You can assume the scene is safe because I told you it was. Nothing tricky here. Not sure what RTA means (Dust?)

GCS=1,2,1 Pt is minimally responsive to painful stimuli as previously described. SpO2 is 97% with the NPA and O2. You cannot check ETCO2. The son tells you she is on Glucophage, Atenolol, Elavil, Norvasc, Lipitor and Aspirin. No recent illness or injury. The son last talked to her at lunchtime when he called home.

Your BGL is 132 (you didn't think it was going to be that easy did you?). Pt gags as you attempt to do laryngoscopy. IV is started and BP remains the same.

Not sure exactly what you want to know as far as sign of OD. There are no pills in her mouth. No signs of trauma to the front. No pain patches in her mouth or anywhere else on her body. Pt takes the NPA without difficulty.

No signs of trauma to the back. You flip her over. She is breathing with some gurgling at a rate of 8/min. You give her a sternal rub and she just moans a little. HR is 130, BP is 80/40. The son tells you she has a h/o hypertension, diabetes and depression.

You have learned well, young padawan.

Realizing that many of my most recent posts have been far from educational (unless you consider bovine bleching habits educational) so I decided to test your brains with another scenario. You are called to the residence of a 40y/o woman who was found unconscious by her son. He greets you at the door looking very upset and brings you down the hallway where you find the pt laying prone in the doorway to her bedroom. He says that he just came home from work and found her as is. She has not moved or responded to his attempts to wake her up. What do you want to know/do? (Assume the scene is safe).

Pelvic Inflammatory Disease

I think this kid has PID. Note- For those with trouble picking up on internet humor (such as myself) that is a joke.