medicgirl05 Posted December 12, 2011 Posted December 12, 2011 Occasionally a high level of cortisol, as a reslt of hydrocortisone, can cause symptoms of Cushings disease consistant with a blueish skin pigmentation? This also meets the declining mental status.
Just Plain Ruff Posted December 12, 2011 Posted December 12, 2011 and to think I thought he might have just put on the blue make up just for you guys.
DartmouthDave Posted December 12, 2011 Posted December 12, 2011 (edited) Occasionally a high level of cortisol, as a reslt of hydrocortisone, can cause symptoms of Cushings disease consistant with a blueish skin pigmentation? This also meets the declining mental status. Hello, Interesting. I am going to look this up on Up To Date. Cheers! Edited December 12, 2011 by DartmouthDave
tniuqs Posted December 12, 2011 Posted December 12, 2011 Ok can I play yet mobster ? I deleted my initial post .. I guess no one picked up on what I was thinking ? What was haemoglobin again and Crit ? EtC02 79 on sidestream ..... must be the machine screwing up Blood labs are normal except a venous PC02 of 82 .. What no venous PH ? Just what was the definition of cyanosis again ? I can't just remember, must be getting old I guess . Not to mention altered pt's BGL! 8.3mmol ... so is that a big deal ?
DFIB Posted December 13, 2011 Posted December 13, 2011 (edited) Since I like going out on a limb and pulling ideas out of what Kiwi calls “some orifice” Here goes. This guy could have a bunch of things 1. Could he be having an allergy to the Cephalexin that has been masked in severity by the hydrocortisone. This is only viable if Cephalexin was taken prior to blue tint. Possibly an anaphilactoid reaction. Also if he is having a reaction to the antibiotic and was already becoming cyanotic, could a Cephalexin reaction have potentiated an already blue skin color. How long ago was his first dose of Cephalexin? Is he allergic to Pennicillin? 2. Although his BP seems inconsistent with a tamponade we don’t know what his BP usually is, so. How many mmHg does his Blood Pressure usually run? Does he have Jugular vein distention? This is not likely since he is calmy sitting but I have to ask. Does he have muffled Heart sounds? Has he gained weight while in hospital? 3. Has he been exposed to chemicals such as poisons or silver? Edited to ask: Is he anemic? And Eydawn has a good point. If he has been in the hospital for two days why isn’t he compliant to his meds? Edited December 13, 2011 by DFIB
mobey Posted December 13, 2011 Author Posted December 13, 2011 Ok can I play yet mobster ? I deleted my initial post .. I guess no one picked up on what I was thinking ? What was haemoglobin again and Crit ? EtC02 79 on sidestream ..... must be the machine screwing up Oh no you didn't. Please see PCO2. lol Blood labs are normal except a venous PC02 of 82 .. What no venous PH ? Ooops... forgot, good thing someone asked 7.21 Just what was the definition of cyanosis again ? I can't just remember, must be getting old I guess . I'll leave that for someone else, but a great discussion point IMO Not to mention altered pt's BGL! 8.3mmol ... so is that a big deal ? I was commenting that all altered patients get BGL tested. 8.3 is a normal reading Forgot one more thing, when the patient first presented he was hyperkalemic. Had insulin to decrease it, and is normal now. I dunno how high it got, wasn't in the reports. How long ago was his first dose of Cephalexin? Over 24hrs ago Is he allergic to Pennicillin? No 2. Although his BP seems inconsistent with a tamponade we don’t know what his BP usually is, so. How many mmHg does his Blood Pressure usually run? To know that he would have to go for checkups, if he went for checkups his doc would sewer him for not taking his meds. Therefore, he does not know his normal BP. Does he have Jugular vein distention? This is not likely since he is calmy sitting but I have to ask. Can't tell, to obeise Does he have muffled Heart sounds? I don't know what non-muffled heart sounds in an obeise patient sounds like..... so I would have to default on this question. I just don't listen to hearts enough to be proficient. I don't really know of any prehospital personell that do. Interesting question., Has he gained weight while in hospital? He has only been there 2 days, and I don't think they hauled his ass onto the scale more than once. 3. Has he been exposed to chemicals such as poisons or silver? No more than anyone else. Remember the cyanosis started while in hospital. Edited to ask: Is he anemic? No And Eydawn has a good point. If he has been in the hospital for two days why isn’t he compliant to his meds? To clarify: He is compliant now.....
tniuqs Posted December 13, 2011 Posted December 13, 2011 Oh no you didn't. Please see PCO2. lol I will get right on that, but was that PaC02 ? PvC02, ETC02 just to clarify ? Blood labs are normal except a venous PC02 of 82 .. What no venous PH ? Ooops... forgot, good thing someone asked 7.21 And you forgot to mention Insulin, hyperkalemia, any other meds you forgot to mention or labs CBC, HGB ?? ...and what's urine output like ? It should be in the chart under Ins and Outs . I think chbare may be interjecting rather soon but your not getting any mercy from this Pirate now !
DFIB Posted December 13, 2011 Posted December 13, 2011 (edited) With a history of CHF I would expect the hospital to weigh him every morning before breakfast but not being a floor nurse I could be wrong.. Muffled Heart sounds are in the EMT literature as one component of the cardiac tamponade triad but I was not aware that listening is not a common practice. Note to self, skip listening to heart. I am going to have to wait for the big guns to chime in. I am at a loss as to what the problem is but still lean toward the Keflex having something to do with it. Edited December 13, 2011 by DFIB
tniuqs Posted December 13, 2011 Posted December 13, 2011 With a history of CHF I would expect the hospital to weigh him every morning before breakfast but not being a floor nurse I could be wrong.. They the RNs and RNA's are so overworked as it is, that's if buddy is even ambulatory. Oddly no one has asked this patients weight yet, just obese ? you know just in case he codes and your down to mgs / kg. Sounding like he would be a beotch to intubate too . Look to prescribed meds and remember that ~ 50 % of CHF are COPD as well, did mobey say he was CHF .. he will not even answer what the patients feet look like "oedema ? pitting ? that bugger .... Muffled Heart sounds are in the EMT literature as one component of the cardiac tamponade triad but I was not aware that listening is not a common practice. Note to self, skip listening to heart. Nope disagree, listen to every lung field you can, listen to heart sounds as much as possible too .. focus on gallops, slushy noises and clicks and tell the MD I had a difficult time hearing heart sounds you may get a good inservice for that observation. Did mobey say any ECG changes, nope, well not so far anyway, but curious with hyperkalemia a pre existing condition ... for shame LOL. I am going to have to wait for the big guns to chime in. I am at a loss as to what the problem is but still lean toward the Keflex having something to do with it. Hey Hey HEY .. you are a big gun here, your asking great questions DFIB and mobey is giving honest answers .. I love the JVD answer as one of my pet pieves on every PCR I saw in ICU .. no JVD, this when patient was lying on a his back on a LSB .... hilarious. What tells me a lot with this senario is loading with Bug Juice and Roids .. again its a shotgun approach to medicine not an internist's sniper rifle . cheers
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