ERDoc

OK, it says for a febrile seizure to give tylenol. That makes sense now. I thought we had a new form of coma cocktail, guess we could have called it the pediatric fever cocktail.

Eww. Nope, no enemas here. That's what nurses are for (just kidding Rid). But hey, I'm back on top for a few secs.

It's my turn on top.

I've been staying out of this, but Tylenol supp for a pediatric seizure? Did I miss that day of med school?

Sorry Hammer, I'm going to have to disagree with you. The death is probably the result of severe internal blood loss. This guy probably has a liver and spleen the thickness of pancakes which just let loose once the pressure on them is removed. The aorta and illiacs have probably also seen better days. You are not going to get a build up of toxic products that quickly. Even electrolyte shifts should not happen that quickly.

An abscess looks like the opposite of a mass. The center is dark and there is a white ring around it. Here is what it looks like:

She has 2 brain lesions (most likely mets from the breast ca) and 2 bone lesions. The black surrounding those masses is edema. That "bump" she got on her head was actually a lytic lesion in her skull. While she contributed all of her symptoms to the two accidents, they were red herings. Her chest xray that was done in the ER also showed a few masses. CT scan of the chest the next day did not look good at all. She has a pretty poor prognosis.

That emergontologist comment was a joke. I hate the term, I am but a simple ERDoc.

To stop Punisher from whining, I have finally included the CT.

Hey, cut me some slack. I'm an emergontologist , not a radiologist. You've obviously never worked at my hospital.

Arteries are covered in smooth muscle that spasm whenever there is an injury (just ask anyone who has ever missed an ABG, the second time is even harder). If the pressure coming down the pipe is higher than the spasm force then you will get bleeding. Veins don't have this compensation mechanism so they tend to bleed more. Luckily they are such low pressure vessels that it doesn't take much to stop them from bleeding. Organ injry such as splenic and liver tends to lead to massive blood loss because they don't have such mechanisms.

Now that's what I'm talkin' about. I will have the CT up for you soon.

So, if someone can enlighten me as to how to post pics (jpgs), you may have some of your questions answered.

So, it sounds like no one thinks this lady is crazy. You arrange for an intercept from that ambulance service with the really cool ambulances (does anyone know their name?) and now have whatever you want at the push of a button. Which buttons would you like to push?

Ahh! Education showing its ugly head. When you assess visual fields you find a left temporal hemianopsia. No cardiac history. Only history is breast ca and only PSH is the mastectomy. No drug abuse and only other med is milrinone (which is confirmed by looking at the bottle and checking the pills on poisendex).

Delta is used for priority dispatching. Check out this link to get our local version of Medical Priority Dispatch codes. http://www.fordyce.org/scanning/scanning_i...cfcodes.html#A6

I'll let you guys talk about the field work, but once in the ER we need FS, pulse ox, rectal temp. A good physical exam would be helpful. Then we need to procede with an AMS workup and I would pan scan as we cannot rule out some form of trauma. If there is nothing we can fix immediately (hypoglycemia, narcotic OD), then this guy has got himself an 8.0

Rectal temp is 98.4 She has the bottle milrinone and says that her PMD says it was for what he thought was cyst on her head. You probe a little further and she says that the reason she decided to call today was that because when she was driving with her father he yelled at her to watch out for a car that was coming straight at her that she never saw. She also noted over the last two days she has been hitting the bushes on the right side of the road when she drives.

She says she was the driver in a low speed MVA. She was hit from behind while stopped at a light. Minor damage to the car. She took the ambulance trip to the ER, but she was not boarded or collared. She had a slight whiplash injury that since gotten better. She was wearing her seat belt and the airbag did not deploy. She was told to take some motrin for pain and vicodin for breakthrough, but never needed the vicodin. She denies any blurred vision, but states that some things to the left seem to disappear and occasionally startle her. She also starts to tell you about a bump on her head that she got when she was on a cruise 6 months ago that has not gone away. Her PMD felt it was a cyst and prescribed milrinone. She denies n&v. Family states there is no history of seizures and they have not witnessed any. PMH is significant for breast ca, s/p mastectomy and chemo 1.5 years ago. She has seasonal allergies for which she takes zyrtec. VS 92 146/84 16 99% on RA She is A&OX3, GCS=15 Pt seems anxious with hurried speech, her hands seem to tremble Visual acuity is 20/20 in both eyes with her glasses on EKG shows STach at 106 FS=106 She has 2+ reflexes througout 5/5 strength in all extremities No asterixis. Pt can do heel to shin and rapid repetitive movements without difficulty. ENT exam is unremarkable. Your ambulance is not one of the really cool ones with a CT scanner or lab. Anything else you want to know about the history or the physical? Do you think this is something legitimate or is it supratentorial?

A 49y/o female calls because she has been feeling, "some vertigo," has been unable to concentrate/focus, and says she doesn't always see things. This has been happening on occasion since she was in an MVA 1.5 months ago. She states that over the last 3 days it has been getting progressively worse.

We could always break out the Mark I kits. For dramatic purposes we could also inject them intracardiac (like they do in the movies).

Not sure what you are asking, but the first step would be to post in the correct forum.

Asys, you will have to become more patient friendly. Try giving them a hug, I have used this approach many times with a good success rate. Isn't worth it to put this whole darn thing to rest. Really, can you not just make that sacrifice for the good of the city. :wink: Do you think we have buried the troll yet?

Just trying to throw some chlorine into the gene pool. Should chlorination be an ALS or BLS skill?

Having a "stuffed shirt" and being the only doctor on this site (at least as far as I can tell), I declare that I have the power to take away everyone's ability to give narcan. From this day foward, your protocols will no longer allow you to give narcan. This should end the debate over it and take away the food from the trolls!!!!! :? :? Let's hope this gets locked soon.