What is with this guys throat

[Doczilla]

Nipple line up is classic PE....

I haven't heard this before. I polled several of the other faculty, and they haven't either. One is very well acquainted with the PE literature, having reviewed and edited articles on the subject, and had never seen it. The best anyone could come up with is that it indicates central cyanosis, which fits with a large PE, particularly if the cyanosis didn't clear with appropriate resuscitation. It would be consistent with a thoracic aortic dissection with occlusion of the brachiocephalics and carotids, but not pathognomonic for PE. This would also fit with SVC syndrome or ventricular rupture.

'zilla

[Kaisu]

I haven't heard this before. I polled several of the other faculty, and they haven't either. One is very well acquainted with the PE literature, having reviewed and edited articles on the subject, and had never seen it. The best anyone could come up with is that it indicates central cyanosis, which fits with a large PE, particularly if the cyanosis didn't clear with appropriate resuscitation. It would be consistent with a thoracic aortic dissection with occlusion of the brachiocephalics and carotids, but not pathognomonic for PE. This would also fit with SVC syndrome or ventricular rupture.

'zilla

After Dwayne mentioned it, I knew it was right and that I had heard it somewhere before. I went over my notes from paramedic classes and it is one of the S & S that we were taught for PE. My classes were taught by a true legend in the state, #5 NREMT-P, masters degree, 30 years in the field and instruction. This is a teacher that is now in the classroom 2 days a week and on clinicals 3 days a week in a busy ED. I can't specifically cite references for where he comes up with this as a S and S of PE, but I would bet your life on it ;-)

Take care.

[DwayneEMTP]

[i don't believe I was way out there. Like described,...

"Bloody hamburger meat" appearance in the back of the throat. With "a lot of blood" in the mouth. How much is a lot of blood?...

Good questions that might have been asked before taking a shot in the dark.

You never did state if there was any emesis noted on the ground. Is the blood pooled in the mouth or coming from the mouth?

Good reason for that. Wasn't my scenario. Another good question to be asked before guessing.

Maybe since I've been around it a lot, but, I can't see where chewing tobacco can be mistaken as bloody tissue.

Me either, but it’s the only direction I could think of to go. I didn’t want to go further than that until others had a chance to come of up intelligent ideas, as opposed to my lame idea. It’s kind of how these things work…You’ve been here long enough to know that.

Why can't you visualize the epiglottis or Larynx? Don't you have intubation equipment?

Sure, but we weren't there in the scenario. When I see a throat full of crap, my first effort isn't to stick a blade into it. I would have been ok with your answer had you claimed to have moved the "hamburger" before going to varacies or eppiglottitis. I have to believe you're smart enough to know there was no way to get to those those diagnosis without visualizing the airway.

Is the cancerous tissue blocking it? If it is, then he must have already been having a lot of raspatory problems already.

I have seen where a patient has had epiglottis and had been coughing so hard that it caused trauma to the esophagus, epiglottis, and tongue. If you've ever tubed anyone with epiglottitis you can see where it can be very inflamed, making everything look like a raw oyster. Severe irritation can cause that inflamed tissue to bleed, hence bloody meat.

Can or tell me how many of those swollen epigltti were visible in the oralpharynx? I'm guessing zero.

Many times with throat cancer, what comes along with it? Esophageal Varices. Whether it be from tobacco use or chronic alcoholism.

Again, we didn't know it was cancer, so now you're simply grasping at straws and making excuses.

Again, another post to call someone out instead of PM'ing to ask personally. :roll:

I didn't call you out. I made clear statements stating I had issues with your answer and your post in general. You decided to be offended and continue to spout silliness instead of simply addressing it as an adult.

This is a learning forum. People may have learned from my opinion of your post and your anger with mine. If you need to be pampered in PM then perhaps you should consider your posts a little longer before posting.

And if there are many of you resolving these issues in PM, you should be ashamed of yourselves. It makes you weak, and we come her to become stronger. Keep your issues out in the open where others can learn from them! That’s why we’re here, right?

Your post was weak because you chose to guess instead of asking for the information you needed to make an educated assessment. Don't blame me for your hurt feelings when I point that out.

Dwayne

[reaper]

After Dwayne mentioned it, I knew it was right and that I had heard it somewhere before. I went over my notes from paramedic classes and it is one of the S & S that we were taught for PE. My classes were taught by a true legend in the state, #5 NREMT-P, masters degree, 30 years in the field and instruction. This is a teacher that is now in the classroom 2 days a week and on clinicals 3 days a week in a busy ED. I can't specifically cite references for where he comes up with this as a S and S of PE, but I would bet your life on it ;-)

Take care.

This was also mentioned in a class that I was in, being taught by a RTT?

[ERDoc]

I've gotta go with 'zilla on this one. I have done a literature search and could not find anything about the cyanosis as described. It is probably one of those urban (rural?) myths that have been propogated. I think your instructors may be confused with central cyanosis. There is no anatomical reason why a blood clot in the lung would cause cyanosis from the nipples up. I challenge anyone here to find a valid reference, or even better, challenge your instructors to do the same.

[DwayneEMTP]

I've gotta go with 'zilla on this one. I have done a literature search and could not find anything about the cyanosis as described. It is probably one of those urban (rural?) myths that have been propogated. I think your instructors may be confused with central cyanosis. This is no anatomical reason why a blood clot in the lung would cause cyanosis from the nipples up. I challenge anyone here to find a valid reference, or even better, challenge your instructors to do the same.

Wow, this is interesting. I also was taught this in Medic school. I've also been involved with 3 PEs that I'm aware of, at least they were reported to me later as PEs by the ER Docs, but I didn't see the paperwork myself. Two in the ER and one I lost in the back of the ambulance. Each had the "classic" cyanosis from the nipple line up and it was reported to me as common knowledge that this is a common PE symptom. Looking back though I don’t remember seeing it with my own eyes until after they were pronounced. Not sure if that’s important or not.

I have looked afterwards for some reason for the cyanosis from the nipple line, as each certainly had a clear line laterally, and I believe full circumference though didn't verify that it crossed the back, but can't find anything that would explain this.

My apologies for reporting what I believed to be common knowledge as fact without making the effort to verify it first. I will look for some sources....

Have a great day all.

Dwayne

[chbare]

I have to go with the docs as well. I have seen many pulmonary embolism patients. True, many had central cyanosis; however, central cyanosis is not exclusive to PE. I have never seen the classic nipple line up cyanosis however.

Take care,

chbare.

[letmesleep]

Actually, I'm going to have to side with the Docs here as well. I will also do some further research, and post it at a later time. With that said, I do agree that there is noted central cyanosis with PE, but I think (as I said I will research this) that the "nipple line" cyanosis that is being described here is related to "traumatic asphyxia" as a "classic sign". You can also see this develope in a cardiac arrest after compressions have been on going for some time, due to the injury caused by said compressions.

I will do some looking around to qualify my statements here, please be patient.

[Kaisu]

Super good post all. Chalk it up to personal hubris to argue with a bunch of docs. I guess it goes with the paramedic mentality. I look forward to any further information that any of you post.

[firedoc5]

Good questions that might have been asked before taking a shot in the dark.

Not a shot in the dark, just one of the first things I think of with that description of an airway like that.

Good reason for that. Wasn't my scenario. Another good question to be asked before guessing.

Sorry about that. Realized that after I already posted and forgot to go back and edit. What's wrong with guess when you have an idea that's a possibility? And besides, I've "guessed" on many other scenarios and was right on the money.

Me either, but it’s the only direction I could think of to go. I didn’t want to go further than that until others had a chance to come of up intelligent ideas, as opposed to my lame idea. It’s kind of how these things work…You’ve been here long enough to know that.

Sure, but we weren't there in the scenario. When I see a throat full of crap, my first effort isn't to stick a blade into it. I would have been ok with your answer had you claimed to have moved the "hamburger" before going to varacies or eppiglottitis. I have to believe you're smart enough to know there was no way to get to those those diagnosis without visualizing the airway.

Guess I'm guilty of assuming most people would have done the basic thing and attempt to move it. If is is a cancerous mass, I wouln't advise removing it prior to a scope. Forgot what happens when you ass-um-e.

Can or tell me how many of those swollen epigltti were visible in the oralpharynx? I'm guessing zero.

Not without a scope.

Again, we didn't know it was cancer, so now you're simply grasping at straws and making excuses.

No excuses. When seeing a mass in the throat, or almost anywhere else, you have to think it could be cancerous. I learned that from patients I had to take to radiation/ cobalt treatments, one of those being a fellow firefighter who had throat cancer. I was able to see his throat when helping to treat him, and post-mortem

I didn't call you out. I made clear statements stating I had issues with your answer and your post in general. You decided to be offended and continue to spout silliness instead of simply addressing it as an adult.

This is a learning forum. People may have learned from my opinion of your post and your anger with mine. If you need to be pampered in PM then perhaps you should consider your posts a little longer before posting.

And if there are many of you resolving these issues in PM, you should be ashamed of yourselves. It makes you weak, and we come her to become stronger. Keep your issues out in the open where others can learn from them! That’s why we’re here, right?

Your post was weak because you chose to guess instead of asking for the information you needed to make an educated assessment. Don't blame me for your hurt feelings when I point that out.

Dwayne

Of course I was offended. Seems like you were implying that my post was detrimental to those with less experience. Who wouldn't be? But I was not angry. It takes a whole lot more than that. You asked my explain myself of why I posted what I did, and that's what I did.

PM'ing is not pampering. Many have used it, and still will. Like you said, this is a learning forum. If they've learned something from it, great. Nobody else has posted, or PM'ed, me with having a problem with what I posted.

And there is a difference between asking about the reasoning of a post and putting the post down.