ERDoc Posted December 17, 2007 Author Posted December 17, 2007 Can the tonsil and adenoids actually become inflamed enough to obstruct the airway significantly enough to cause dyspnea? If so, what conditions are we seeing on visual inspection of the oropharynx? Any relief with the albuterol? Yes they can. The oropharynx appears clear and patent. As I said before, there is a small puncture to the left tonsil. No change with albuterol.
ERDoc Posted December 17, 2007 Author Posted December 17, 2007 Hmmm, hospital sounds like a nice place to go You are 100 miles from the closest hospital and due to too many accidents, your company has placed a governor on the ambulance that limits the speed to 30 mph. :twisted: Nice try, but you cannot pawn this one off on those sexy ER doctors.
Lone Star Posted December 17, 2007 Posted December 17, 2007 You are 100 miles from the closest hospital and due to too many accidents, your company has placed a governor on the ambulance that limits the speed to 30 mph. :twisted: Nice try, but you cannot pawn this one off on those sexy ER doctors. I'm sure Life Flight from the U of M would be more than happy to bring this young man to you!
Timmy Posted December 17, 2007 Posted December 17, 2007 Damn you!!! That is so unrealistic! I wana try get this 02 stats up a bit more, maybe into the mid 90s before we load. But with nill effect with albuterol I would assume you would have nill effect with Ipratropium or any other related meds? How’s our ECG looking? I’m starting to swing towards some trauma in the throat more than a medical problem? But saying that your tonsils really aren’t located down that far to cause major airway problems… Since were far out what’s our med control saying to do? And the radio is working!
ERDoc Posted December 17, 2007 Author Posted December 17, 2007 I'm sure Life Flight from the U of M would be more than happy to bring this young man to you! Bad snow storm, no one is flying. No trains are running either.
ERDoc Posted December 17, 2007 Author Posted December 17, 2007 Damn you!!! That is so unrealistic! I wana try get this 02 stats up a bit more, maybe into the mid 90s before we load. But with nill effect with albuterol I would assume you would have nill effect with Ipratropium or any other related meds? How’s our ECG looking? I’m starting to swing towards some trauma in the throat more than a medical problem? But saying that your tonsils really aren’t located down that far to cause major airway problems… Since were far out what’s our med control saying to do? And the radio is working! Nothing you do gets the pt's sats above 85%. Radios and cell phones are down. The mother tells you that the kid had a sore throat for the past few days. He saw his primary who told him there was an infection in the left tonsil that needed to be drained. The sent him to a Dr. Harry Johnson. The mother hands you the card and it says he is an ENT specialist. She says that they sprayed his throat with some numbing spray and then used a needle attached to a syringe to drain some "ugly yellow looking stuff". EKG looks fine.
Timmy Posted December 17, 2007 Posted December 17, 2007 Well I’m stumped! It’s not an allergic reaction to the spray because we’ve already ruled that out. I have seen a doctor a aspirate a lump in patients throat before, he made it very clear that it was important not to swallow any of the fluid but we’ve ruled out any toxic related problems. It not like a cyst or tumor or anything like that? Interesting to see what the blood test showed up and culture of this yellow fluid…
Lone Star Posted December 17, 2007 Posted December 17, 2007 Anaphalactic reaction to the local?... As a basic, all I can do is load him up and scream really loud for an ALS intercept!
Kiwiology Posted December 17, 2007 Posted December 17, 2007 Shirt, this is an interesting one. Breath sounds? Good bilateral? Wheezy? Crackly? I am either thinking some sort of airway obstruction (maybe do a laryngascopy) and check for swelling or some sort of hypoxia. As my clinical guidelines say, oxygenation and ventilation are two different things. If the O2 is only 85% then something is preventing oxygenation despite good ventillation. If this kid can breate w/o difficulty it rules out some sort of airway obstruct but I'd still like to take a peek down the throat with a laryngascope just to rule out anything (never say never) stuck down there. Whats his EKG/BP looking like? My concern is that if this kid is stressing out trying to breate and he keeps on doing it, getting tired in the process he might PEA out (had a severe asthmatic do that) so I want to prevent that. I would be looking at the lungs, seeing if they sound clear and good equal breath sounds because I'de be looking at worst, maybe a pulmonary edema which would fix with the hypoxia. Unlikely I know but still. If thats not it then I would be thinking maybe something cardiogenic or edema wise hence the breath sounds. I want to get this guy on a 12 lead and take a good look at the breath sounds, maybe take some bloods for sampling and keep high flow O2 with the allbuterol and try some IM adrenaline if his O2 is still ~85% if the bronchodialators don't work. I would also want to get in a cannula in case he codes out or goes into PEA.
unknown Posted December 17, 2007 Posted December 17, 2007 You are 100 miles from the closest hospital and due to too many accidents, your company has placed a governor on the ambulance that limits the speed to 30 mph. :twisted: Nice try, but you cannot pawn this one off on those sexy ER doctors. I say Helicopter at this point! This kids needs intervention. Aggressive airway will be needed and due to the distance the time of travel and the govner on the ambulance-- where shall I have my crew meet your ground truck???
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