mobey

have you seen Ab's?

Potentially yes. I was not allowed on practicum until I proved that MMR were up to date, and TB test was either neg, or inactive. Talk to the school.

Luck?? No I wish you success.

Naaa... not a hit at all. I will agree it is a decent starting point, as long as the information registered into your long term memory comes from a credible source. My post was less about giving you a finger thwap, and more about sending a message to all the new members here (as we have really increased our numbers lately). A lot of people don't know that anyone can modify Wiki

I do not work for National Geographic.... nor any advertising company. If you think you work in high pressure situations with crappy resources and terrible conditions....... or just love really cool s**t.... You need to be watching "Inside Combat Rescue" http://www.youtube.com/watch?v=8Rc4_2_YXuw The series so far is on Youtube. I would love love to chat with one of these dudes if we could ever get one on the forum.

Don't feel bad Hells, I learned about it on Facebook so it is no doubt you had never heard about it j/k I actually learned about this on this forum, I think it was back in the days when Paramedicmike posted scenarios. This is the 2nd case I have seen prehospital.... funny since I work rural, and don't have nearly as many calls under my belt as my urban counterpart. Either way, luck of the draw with these rare cases in North America. BTW: Jaymazing: I almost had to Cyberslap you for linking Wiki, I was glad to see an ncbi link alongside it. I remember back in the day someone using Wiki as a cite and a member here (I think Spenac) went into Wiki and changed the entry in the link to something sarcastic just to show the new member how easy it is. All yu have to do is start a Wiki account and you can edit any entry, that's why you will not see it cited in credibal medical informational sources. I can appreciate that it is a decent place to start when you have NO IDEA what the illness is.... as long as those reading know that Wiki is only opinion.... not fact. Thx for playing everyone!

Bing! Right diagnosis, wrong cause. The original injury caused a bulging disc which was not seen on X-Ray by the family Doc. Simply moving the wrong way recently started an inflammitory process which resulted in cauda equina syndrome. The fever is from influenza. I initially thought GBS as well, however I was not convinced when there was only one limb affected..... Once he lost control of his bladder, and most importantly, felt nothing with urination - Cauda equina moved to the frontline. I'll let someone who has never heard of the syndrome before find some articles to link here. Thanks for playing!!

Oh: and no tick bite, with or without associated Halo

So.... As you begin to load this guy onto the cot via "Slide yourself over buddy"... He suddenly voids his bladder in his pajamas. "holy Sh*t, I didn't even know I had to go!!" He is super embarassed, and swears he felt nothing... he just sees the urine and puts 2 and 2 together.

ER Doc: No drug use. Dave: Finally I am starting to think slightly more like you! GBS was also my 1st thought. His BP is equal bilat. The patient states the pain is like a electric shock going from his right buttox down to his ankle, then no feeling at all on the bottom of his foot. Ankle reflex is absent. Now that some pain is decreased you ask him to stand, which he does and can do so unassisted. He is not willing to try walk for fear of falling, and he is unable to bend his knee while standing stating "It feels like my foot is too heavy to get off the floor"

The CT is cancelled, he is being transferred to a big city centre to be assessed by neuro and expedited CT. 2 Years ago he did hurt his lower back lifting concrete. Fever/sniffles came on 2 days prior to backpain.

Thx for posting. Obvioustly something to refresh on.

Since our "Dyspnea" patient is long dead, I thought I'd start a new scenario. The old dawgs here have seen this before (Ya Dwayne... that includes you), so I trust you won't spoil it for the rest. A 27y/o obeise (230lb) male presents to the ER with runny nose, malaise, and fever. He is having 10/10 pain in his lower back. He is walking semi-hunched over with little steps. He is given 10mg Morphine, Naproxen, and gravol and scheduled for a CT the next day. Bloodwork is normal overall with slightly elevated WBC. Vitals are normal X-Ray of lumbar is normal..... as interpreted by the smalltown family medicine doc. The next morning the patient awakens with pain shooting down his right leg and numbness to the bottom of his right foot.

I take that as a compliment these days

I'm man enough to say I have no friggen clue. Someone start posting answers and stop waiting to see what everyone else is doing!

I know you didn't ask me, but I'm going to chime in anyway. A fluid bolus would be concurrent with Epi in the above patient, as would ventolin and steroids with Benadryl. None of the above treatments outside the fluid bolus would be administered for a patient experiencing primary hypotension with no other symptoms. I have a sneaking suspicion this never was an allergic reaction at all....... Some will remember the scenario I once posted with the attached research regarding atypical anaphylaxis. Do remember the definition of anaphylaxis is "Allergic reaction affecting 2 or more body systems" Oh BTW Kate: I am having a real difficult time staying away from smart ass latex remarks right now....

I believe that is called morbid obeisity

Which is funny, because a code is the shortest paperwork I do.

I have had plenty (10+) patients die in my ambulance. If a patient codes during transport we pull over & work it. The ER is not going to do anything I can't out here hours away from a major trauma centre, The science just does not support a rolling code. I personally take no pride in abusing a corpse so I can chant these rediculous chest pounding mantras with the rest of the monkeys.

I will also echo what has been said. The BIG seems attractive d/t price. But after a few failed I/O, companies end up buying the EZIO.

Ahhh... well that changes things!! Lets throw the leads on with those pads and sync! I'll cardiovert with my new zoll x series please! I doubt it will work with all the adipose tissue.... but start at 120j Biphasic to make the auditors happy Does she have a temp?

Prolly gonna be a Cardiogenic shock (Low pressure pulm edema) Throw the pads on for a lead 2 interpretation, 12 lead can wait. I just need rate & rhythm for now Try for a BP, if we can't get one, depending on rhythm, we will get Dopamine up right away. I'm happy with npa/BVM for now, we can keep the PEEP valve nearby, but I need a BP before we do anything else. Forgot to ask: How far to hospital? Is there an emerg department? cardiology?

I wish I had more time for a lengthy reply, but here is my opinion. As a passionate Paramedic with Ankylosing Spondylitis that has led to degeneration of my hips and lower spine, suffering from migranes once a week and on immunosuppressant injections - I say you can only live one time (probably). Some people are given crappy biological structures to do what we can during our life, so that's what I do. Lift as little as possible. Avoid high impact activities (jumping out of back of your rig) Walk on flat surfaces whenever possible (avoid falls) Utilize backup Eat healthy, and take your meds. When you can no longer work..... stop. If you do not have the "EMS bug", then just quit now...... But I can't..... I'm hooked, and i'm gonna give my disease a run for its money!

I think the primary culprit is OD. The symptoms of the OD are unconsciousness, resp depression, hypotension, hypothermia. The result of the symptoms is: Unconsciousness = Rhabdo Hypothermia = bradycardia Hypotension = Neuro event (CVA?) It is a fair argument to say that cerebral edema and/or swelling is at play here causing increased ICP.... I would just like to see higher BP before I go down the herniation pathway as hyperventilating an already injured brain could be pretty detrimental. But hey.. your the jungle cowboy I don't think there is a right or wrong answer here. I would like to start flooding her with fluid (foley would be nice). I like Hartmans solution here because it has a higher ph. I would get the Dopamine up ASAP, Levo would be a great adjunct too, but we don't carry it. The Dopamine will help give the kidneys a little boost too.

I'm going to go against the ALS grain here and stick with MariB. I actually don't want to intubate, for fear we may be seeing a bradycardia due to hypothermia. Laryngoscopy will only increase vagal tone, and put the patient at an unacceptably high risk of asystole. If you do not buy that, how about this: With a BP already incompatible with life, removing the "bellows pump" of the thorax (negative pressure in the right atria on inspiration causing increased preload) could very well kill this patient. We have to approach these cases from a "most life threatening" position. She has been ventilating (somewhat) up till this point. Adding a BVM with 100% o2 and NPA with OPA may just buy us some time to build up a pressure that will make intubation safer. That all said..... I see the pressure is up now so I'll quiet down. Oh ya.... Dwayne, although I do intuitively agree with increased ICP, it is pretty low on my suspects right now with the low BP. I don't disagree with a catastrophic brain injury though.