Arizonaffcep Posted December 8, 2008 Share Posted December 8, 2008 He is a tree cutter and is the guy that climbs them. Good pulses in all extremities. Cap ref<2sec in all extremities. Temp 98.2. 2 point discrimination is decreased over the lateral aspect of the shin from just below the head of the fibula down to the dorsum of the foot. What does it feel like (thinking a compartment sydrome thing)? Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 Hmm... Quiet a challenging case. STI means Soft Tissue Injury and ?# is Query Fracture. I've had football players with similar complaints from sciatic nerve problems or a stress fracture in the shin. A tad extreme but is it possible he may have DVT or similar? Everything seems pretty crusiey for the time being, good circulation, still has movement, is able to walk, vitals are good. Not unless there is any deformity or signs of fracture I'm happy for him to walk to the ambulance if he is, if the patient so desires I'm happy to offer some analgesic pain medication if there's no contraindications. Unless things start to go pear shaped I guess there's really not much EMS can do, just a nice quiet ride to the ED for some pictures and further investigation. Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 Arizona, he says is just feels like he can't feel anything. He can tell that he is being poked but cannot tell anything else about it. Dr. Timmy, are you asking for an US? There is no evidence of trauma. What sort of workup would you like to do once you are in the ER? Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 God, now your asking for trouble... Umm, I guess an X ray to start off with, doppler, tap on the knees for reflexes. If everything comes back ok then I may move to a CT of lower back and legs, maybe a blood work up. Failing this, palm him off to someone else for an EMG or similar lol... Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 8, 2008 Share Posted December 8, 2008 Arizona, he says is just feels like he can't feel anything. He can tell that he is being poked but cannot tell anything else about it. Dr. Timmy, are you asking for an US? There is no evidence of trauma. What sort of workup would you like to do once you are in the ER? Actually, Doc, I was thinking more on palpation than Pt perception. Link to comment Share on other sites More sharing options...
EMT Foose Posted December 8, 2008 Share Posted December 8, 2008 I'm going to throw out a guess, mainly because I have to go to school now and won't be able to read this for a while.. The area of deficit follows the dermatome route for L5, so I'm guessing a herniated disk pressing on the nerve root around L5. Either that, or a complete tear of the anterior tibialis muscle from climbing trees. Those are the 2 avenues I would pursue, anyway.. Hopefully I'm not waaay off... Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 God, now your asking for trouble... Umm, I guess an X ray to start off with, doppler, tap on the knees for reflexes. If everything comes back ok then I may move to a CT of lower back and legs, maybe a blood work up. Failing this, palm him off to someone else for an EMG or similar lol... Xray, doppler, CT are all negative. Good reflexes. EMG? Sure, how does 3 weeks from Weds sound? What sort of blood tests do you want? Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 Actually, Doc, I was thinking more on palpation than Pt perception. Sorry, my bad. You palpate the area and do not notice anything unusual. Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 I'm going to throw out a guess, mainly because I have to go to school now and won't be able to read this for a while.. The area of deficit follows the dermatome route for L5, so I'm guessing a herniated disk pressing on the nerve root around L5. Either that, or a complete tear of the anterior tibialis muscle from climbing trees. Those are the 2 avenues I would pursue, anyway.. Hopefully I'm not waaay off... Using the hot and cold game from childhood, I'd say you are lukewarm. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 8, 2008 Share Posted December 8, 2008 I second EMT Fosse's guess --- nerve compression due to: compression in the spinal cord, stress fracture to the ankle or leg, or compartment syndrome to the ankle or foot. Next wildest guess, would be guillian-berra syndrome (early onset -- next foot to follow soon). Link to comment Share on other sites More sharing options...
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