zzyzx Posted August 20, 2008 Posted August 20, 2008 Here's a call I ran a while back... You respond to a "generalized weakness." Your patient is a 20 y/o male who says, "I felt fine last night, but when I woke up this morning, my legs were paralyzed." He has has no loss of function to his upper body, but his legs are too weak for him to stand up. He was unable to get out of bed, and his parents called 911. All his vital signs are within normal limits. He says he does not have any medical conditions and doesn't take any medications.
mobey Posted August 21, 2008 Posted August 21, 2008 Sounds like it could be MS, has this ever happened before? Any recent trauma? including ciropractor.
zzyzx Posted August 21, 2008 Author Posted August 21, 2008 Nope, never happened before. No recent trauma.
mobey Posted August 21, 2008 Posted August 21, 2008 How about numbness or tingling? Has the pt been noticing any other symptoms lately? Joint pain, dizziness, back pain..... What position did he sleep in? Distal pulses present and equal? Skin condition of legs compared to other parts of the body? Assess for strength What's the Pt's temperature? OK my Dd thinking right now... Tumor (spine or brain), MS (not likely), infection, loss of circulation.
mshow00 Posted August 21, 2008 Posted August 21, 2008 SAMPLE, OLDCARTE, family hx, social hx of last couple of days, moniter, IV, blood drawls (if hospital will accept them), PMS check... large bolus of deseil.... First thought: Meningitis. Differ Dx: unknown at this time
zzyzx Posted August 21, 2008 Author Posted August 21, 2008 To answer your questions... He doesn't have any numbness or tingling. He does have some aching pain in his legs. Positive pulse, motor, sensation, but he is very weak in his legs. No back pain. Recent viral illness? He says he felt like he had the flu a few days ago, but now feels fine. Does not appear to be febrile. No difference in skin signs between upper and lower body. He was sleeping on his side. Family/social Hx? He's a 20 y/o Asian male. He lives with his parents, who are non-English speaking Vietnamese. The family is poor. Your partner suggests that maybe the patient is faking his symptoms. The patient does not seem to be in any distress and is answering your questions quite calmly. He doesn't complain of any other symptoms besides what he's already told you.
mshow00 Posted August 21, 2008 Posted August 21, 2008 r/o meningitis vs electrolyte inbalance my best guesses did he eat any chicken lately.... bird flu? (at the risk of sounding incredibly ignorant here)
Recommended Posts