ibemt31 Posted May 22, 2008 Posted May 22, 2008 Hey All. Had an interesting case earlier today and was wondering what you all think or if anyone has had anything similar. We were dispatched for a sick party. We find pd on scene with a gentleman, in his 40s, lying on the ground, but CAOX3, albeit slightly lethargic and grossly diaphoretic and flushed. The pt complains of no pain and simply states he is tired. Pt denies any pervious HX/RX. Pt NKA. Pupils are pinpoint, and up until this point this sounds like typical opiate use. However, once we got him in the bus and got a set of vitals, pt`s vitals did not seem appropriate for someone under the influence of opiates. His vitals were initially HR 140 RR 26 and BP 210/110. vitals and mental status remained consistent throughout the remainder of the call, and nothing else of note occurred. Just wondering what you all think he was on/what the issue was. The pt admitted to etoh consumption and denied an other drug use(which by the way broke my bullshitometer, no i have to go get it fixed......) Speedball maybe? Curious as to what you all think.......
chbare Posted May 22, 2008 Posted May 22, 2008 Most likely polysubstance use. I have also seen similar similar findings with hepatic encephlopathy. Take care, chbare.
mediccjh Posted May 22, 2008 Posted May 22, 2008 Could be a pontine bleed due to the cocaine use. Then again, nothing surprises me down there. I've had a couple of pontine bleeds, and they are 1 of the 4 causes of pinpoint pupils.
p3medic Posted May 22, 2008 Posted May 22, 2008 Not pinpoint pupils from a pon's bleed if he's CAOX3.
Doczilla Posted May 22, 2008 Posted May 22, 2008 I can't think of only one agent that could cause everything that you saw. Brainstem bleed would be immediately and readily apparent on physical exam, as p3 alluded to. Patient would be unresponsive, and respirations would shortly be erratic, strange, or absent. Hypoglycemia can cause some of the things you list, such as the diaphoresis and tachycardia (the body releases epinephrine and norepinephrine to attempt to increase BGL through mobilization of glycogen and production of glucose through gluconeogenesis, thus they are diaphoretic and tachycardic). So can cocaine, but you would expect dilated pupils. Speedball (cocaine/heroin mix) is a reasonable guess as well, with the pinpoint pupils, general sluggishness, and HTN with tachycardia (general sympathetic response). 'zilla
medicgirl69 Posted May 23, 2008 Posted May 23, 2008 I had a very similar experience myself only two months ago. Two patients (ran on each one within 12 hours), both ETOH, pinpoint pupils, elevated HR...but, on FSBS - both were below 30 - no history of medical illnesses besides being methadone clinic patients and no access to any diabetic medications. There were no other substances found at either scene after extensive search. Long story short, they had both admitted to trading their methadone for some "VALIUM" from a "lady at the bus station". The second guy had one of these "Valium" pills left in his pocket and after analyzing it in the drug book at the ER, found the pills were actually glipizide (diabetes medication used to lower blood glucose). Common thing for these guys around my area is to score their heroin and then top it off with Valium and a healthy dose of King Cobra. Makes you wonder if these two will think twice about buying their "Valium" from that woman at the bus station again...but I doubt it!
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