Two Medical Call Reviews

[celticcare]

Interesting patient indeed Rat, few differntial diagnosis points there. Plus a few off topic posts in this thread *but hey that is normal here right *

cold and not well perfusing peripheries will hampen acquiring a decent blood sugar reading. Whilst I know it would have been difficult in the case of this patient, if I have a patient with shut down peripheries, I take my BSL reading from the ear as the head will still have a good supply of blood.

This is pointing probably more to a cerebral call, be it CVA or dementia (probably a combo effect). If you are able to acquire any of the lab values, can you post for me a CK and Trop level please.

In regards to the symptoms posted by NYCEMS, I have seen presentations like the one he described and also similar to those posted in following posts whilst I was doing my Psych rotations (8 weeks worth). The hightened responses however, seemed to come from patients who either had their first insidence of the episode or had underlying pathological issues also. This coupled up to make the effect more pronounced as the body was fighting within itself secondary to an adjustment to new medications. They sound similar though, to tardive dyskenisia.

I am fighting very hard to not go off topic in regards to mobeys comments and also a few others by people. This thread is not to be a bls vs als thing *as the undertone was starting to arise in there*, it is a question of what else could have been done and were the actions so far proper. It might also be Rat's locale policy to acquire a 3 lead strip for the doctors, different areas different protocols. *to echo the great Richard B, Follow your local protocols*.

Volunteer services are common place here in New Zealand for same reasons that Rat mentioned. Some volunteer areas offer ILS care also and it is a love to do the work and stay in your local community. Alot of the volunteers I know, would love to do the job full time, however, they either have family commitments and cannot relocate, or are in steady income as it is and cannot leave due to that. At the end of the day, voly or paid, it is the service to mankind that counts.

Pro utilitate hominum.

Scotty

[rat115]

Scotty, this is an interesting pt, and I wish that I were able to find out more about the final dx on her. The perfusion problem is a normal with this gal with her age and diabetes. This isn't new, but it was worse than normal. As to the the lab results, I really wish that I could get a look at them. It would be a nice wrap up of the call to get a complete feedback on it. It would also help since I have a feeling we're going to be seeing this pt again.

You're correct that it is our policy to get a 3-lead strip for the ER. Considering that this pt was moving around so much when we took her in the 1st time that the ER was unable to get a good 12-lead, I wanted to get one in case she started getting worse again, and I just barely got it before she started thrashing around again.

Oz, you gave an excellent description of a dystonic reaction. The question your description brings up for me, and this is to you, Scotty and any others who've seen this before, is if the pt's speech was slurred or more of a babbling that didn't have any real words mixed in? I ask this because what you described very well what was going on, but she was alternating between slurred speech and where there was no real form to her words. When she'd stiffen up, she'd fling her arms out and writh as if in pain but she told me that she wasn't hurting when I asked her about pain. She didn't say that she was in pain just when she was writhing. At the same point, she told me that she had 27 kids when she has 3 and was born in 3 when she was born in 1927. That made me think neuro with the strong possibility of stroke therefore I wanted to get her to the ER asap. The thought that it might have been something to do with a medication change also occured to me, but she'd had that changed a couple of days before this occured.

I'm asking questions because this is something that neither I or the other 3 EMS providers who worked with me between these 2 calls had seen before. I'm trying to educate myself. I know that I may never know the full dx for the pt, but I want to learn from it. I know that, personally, I made sure to cover as much BLS care as was needed and that could be provided between the time on scene and the time en route.

To all of you who've stayed on topic without the rude stuff added in.... Thanks for helping me and others learn more. For you others, you're the reason that I've been a member of the forum so long and have so few posts. I get sick of the nasty attacks of EMT-Basic vs Paramedic and paid vs volley. Too much of that is total BS, IMO.

[NYCEMS]

Interesting patient indeed Rat, few differntial diagnosis points there. Plus a few off topic posts in this thread *but hey that is normal here right *

cold and not well perfusing peripheries will hampen acquiring a decent blood sugar reading. Whilst I know it would have been difficult in the case of this patient, if I have a patient with shut down peripheries, I take my BSL reading from the ear as the head will still have a good supply of blood.

This is pointing probably more to a cerebral call, be it CVA or dementia (probably a combo effect). If you are able to acquire any of the lab values, can you post for me a CK and Trop level please.

In regards to the symptoms posted by NYCEMS, I have seen presentations like the one he described and also similar to those posted in following posts whilst I was doing my Psych rotations (8 weeks worth). The hightened responses however, seemed to come from patients who either had their first insidence of the episode or had underlying pathological issues also. This coupled up to make the effect more pronounced as the body was fighting within itself secondary to an adjustment to new medications. They sound similar though, to tardive dyskenisia.

I am fighting very hard to not go off topic in regards to mobeys comments and also a few others by people. This thread is not to be a bls vs als thing *as the undertone was starting to arise in there*, it is a question of what else could have been done and were the actions so far proper. It might also be Rat's locale policy to acquire a 3 lead strip for the doctors, different areas different protocols. *to echo the great Richard B, Follow your local protocols*.

Volunteer services are common place here in New Zealand for same reasons that Rat mentioned. Some volunteer areas offer ILS care also and it is a love to do the work and stay in your local community. Alot of the volunteers I know, would love to do the job full time, however, they either have family commitments and cannot relocate, or are in steady income as it is and cannot leave due to that. At the end of the day, voly or paid, it is the service to mankind that counts.

Pro utilitate hominum.

Scotty

WELL SAID.........

Scotty, this is an interesting pt, and I wish that I were able to find out more about the final dx on her. The perfusion problem is a normal with this gal with her age and diabetes. This isn't new, but it was worse than normal. As to the the lab results, I really wish that I could get a look at them. It would be a nice wrap up of the call to get a complete feedback on it. It would also help since I have a feeling we're going to be seeing this pt again.

You're correct that it is our policy to get a 3-lead strip for the ER. Considering that this pt was moving around so much when we took her in the 1st time that the ER was unable to get a good 12-lead, I wanted to get one in case she started getting worse again, and I just barely got it before she started thrashing around again.

Oz, you gave an excellent description of a dystonic reaction. The question your description brings up for me, and this is to you, Scotty and any others who've seen this before, is if the pt's speech was slurred or more of a babbling that didn't have any real words mixed in? I ask this because what you described very well what was going on, but she was alternating between slurred speech and where there was no real form to her words. When she'd stiffen up, she'd fling her arms out and writh as if in pain but she told me that she wasn't hurting when I asked her about pain. She didn't say that she was in pain just when she was writhing. At the same point, she told me that she had 27 kids when she has 3 and was born in 3 when she was born in 1927. That made me think neuro with the strong possibility of stroke therefore I wanted to get her to the ER asap. The thought that it might have been something to do with a medication change also occured to me, but she'd had that changed a couple of days before this occured.

I'm asking questions because this is something that neither I or the other 3 EMS providers who worked with me between these 2 calls had seen before. I'm trying to educate myself. I know that I may never know the full dx for the pt, but I want to learn from it. I know that, personally, I made sure to cover as much BLS care as was needed and that could be provided between the time on scene and the time en route.

To all of you who've stayed on topic without the rude stuff added in.... Thanks for helping me and others learn more. For you others, you're the reason that I've been a member of the forum so long and have so few posts. I get sick of the nasty attacks of EMT-Basic vs Paramedic and paid vs volley. Too much of that is total BS, IMO.

AGREE, POINT WELL TAKEN.... THIS FORUM SHOULD BE FOR OUR ADVANCEMENT OF KNOWLEDGE NOT TO TRASH EACHOTHER. I APOLOGISE TO ALL.

[celticcare]

Thank you for your post there NYCEMS, and no need to apologise in any essence, stick to your guns ad be true to what you hold dear, patient care, not rank or fence posts.

Scotty

[Emtgirl101]

the diabetic women was that way because of her sugar and can make her combative confused, even lil crazy . its the sugar btw was it really low.

[fiznat]

Thank you for your post there NYCEMS, and no need to apologise in any essence, stick to your guns ad be true to what you hold dear, patient care, not rank or fence posts.

Scotty

I'm sorry, but where did anyone turn this into an ALS vs BLS debate? What guns exactly should NYCEMS stick to and what is it that he is holding dear? This warm and fuzzy stuff is all well and good, but it really isn't making much sense here.

[chbare]

I'm sorry, but where did anyone turn this into an ALS vs BLS debate? What guns exactly should NYCEMS stick to and what is it that he is holding dear? This warm and fuzzy stuff is all well and good, but it really isn't making much sense here.

Agreed, a few off topic posts and some disagreement; however, ALS versus BLS? In the world outside of EMS, this whole concept of ALS and BLS really does not exist.

Take care,

chbare.

[celticcare]

I'm sorry, but where did anyone turn this into an ALS vs BLS debate? What guns exactly should NYCEMS stick to and what is it that he is holding dear? This warm and fuzzy stuff is all well and good, but it really isn't making much sense here.

It was turning into the starts of an ALS and BLS debate for the mere facts of people placing the "do not diagnose and you are only a basic" concept within their posts. There was an undercurrent of BLS vs ALS or paragod syndrome in some posts.

Some people practice at EMT-B yet are in training for ILS or ALS also, so does the thought and mindset of trying to think with their new gained knowledge mean nothing. Perhaps it is different in different countries or areas, but here you are encouraged to think and learn, apart from when you get partnered up with ol wol who doesnt think A&P knowledge is essential in the prehospital arena.

Do you need a hug fiznet?

[Ridryder 911]

It was turning into the starts of an ALS and BLS debate for the mere facts of people placing the "do not diagnose and you are only a basic" concept within their posts. There was an undercurrent of BLS vs ALS or paragod syndrome in some posts.

Some people practice at EMT-B yet are in training for ILS or ALS also, so does the thought and mindset of trying to think with their new gained knowledge mean nothing. Perhaps it is different in different countries or areas, but here you are encouraged to think and learn, apart from when you get partnered up with ol wol who doesnt think A&P knowledge is essential in the prehospital arena.

Do you need a hug fiznet?

No, I doubt they do. It's hard to state someone with only a few hundred hours of training and no formal education as in not having a degree to state they make a diagnosis is being asinine. Even stating they can make a clinical impression is stretching it. I even have a hard time accepting most Paramedics as being able to make a good clinical impression can be wishful thinking.

There is no such thing as ALS or BLS except in EMS where they have had to differentiate because of training vs. education. Medical care is medical care, the assumption especially regarding in making a differential diagnosis is much farther advanced than just simplistic signs & symptoms.

There is NO debating this. This is the way medicine is and yes we are division of medicine.

We all can learn no matter what the level but let's be realistic.

R/r 911

Edited April 16, 2009 by Ridryder 911

[oz_paramedic_chick]

Hey with our pt her speech wasn't slurred or bizarre, it was simply hard for her to talk because of the trismus in her mouth. Sorry if I confused anyone!