DwayneEMTP Posted October 19, 2012 Posted October 19, 2012 Please don't say 'prick'... I'm leaning toward a heater malfunction and CO poisoning. Any symptoms in the friends that have been caring for him? Probably pretty early at this point... Cold nights, general failure to thrive, it appears that he's shunting a bit (difficult finger stick), despite shunting he's got an SPO2 of 100%. An SPO2 of 100% in a patient breathing normally always makes me ask "why?", especially when it's cold, or near anything to do with mechanics or heavy equipment. You've mentioned a missing vital sign, do you mean skin color? Or temp maybe? If not, then I don't know. I'd have the hosemonkeys check for it if they're on scene, get everyone out of the house and interrogate the crews and friends for symptoms, otherwise I'd put him NRB/15L, prepare for transport and notify the receiving hospital of a possible CO issue. I'm willing to bet that this will be close...
Curiosity Posted October 20, 2012 Author Posted October 20, 2012 What is his core temp ??? You grab you tympanic thermometer, put the plastic cap on and take his temperature. The thermometer gives you an error, says the cap isn't on. You try again, get the same error, try one more time, same error. So you can not get a temp at this time! Please don't say 'prick'... I'm leaning toward a heater malfunction and CO poisoning. Any symptoms in the friends that have been caring for him? Probably pretty early at this point... His friends have been there all evening, they are not showing any symptoms of CO. You've mentioned a missing vital sign, do you mean skin color? Or temp maybe? If not, then I don't know. Skin color is pale, almost white. When you touch him he is neither hot nor cold. As above, thermometer gives three back to back errors. We've left the scene with a transport time of 7 mins. Was he hypothermic? Well, I can't get a temperature on him. His skin doesn't feel abnormal. If he is hypothermic, how would that be possible? He states he hasn't been outside in days, his friends collaborate his story and the house is nice and tostey.
Kaisu Posted October 20, 2012 Posted October 20, 2012 Underactive thyroid (hypothyroidism), poor nutrition, stroke, severe arthritis, Parkinson's disease, trauma, spinal cord injuries, burns, disorders that affect sensation in your extremities (for example, nerve damage in the feet of people with diabetes), dehydration, and any condition that limits activity or restrains the normal flow of blood.
island emt Posted October 20, 2012 Posted October 20, 2012 You grab you tympanic thermometer, put the plastic cap on and take his temperature. The thermometer gives you an error, says the cap isn't on. You try again, get the same error, try one more time, same error. So you can not get a temp at this time! Thats why you shouldn't have a cheap thermometer on the truck. Those cheapie's won't function when they get a few degrees outside of normal range. We have the same units as the hospitals use. Possible hypothermia due to low circulation , probably poor nutrition, severe depression over the loss of his mother, underlying health problems. In the clinical setting they call it failure to thrive.
Curiosity Posted October 20, 2012 Author Posted October 20, 2012 We have the same thermometers as the hospital. When we got there, we tried theirs and got the same error as in the truck. They found him a room and took a rectal temp. It was 32 C / 89 F. He was quite hypothermic, but not for any of the reasons mentioned above. There's an other scenario posted here where hypothermia was a side effect of a condition a patient suffered. That's what reminded me of this call. The next day, we were told he was in the ICU. His temperature went up only a few degrees despite attempts at aggressive rewarming. I was shocked to find out how hypothermic he was. I got a load of crap from the nurse asking if I had even bothered to touch my patient. I touched her arm and she yelpped, my hands were just as cold as he was. Looking back, I should have realized that anyone sitting inside a hot house for two days should have felt HOT to me, not the same as my hands were. Then there was the artifact looking ECG. He was shivering internally which was causing these bouts of "artifact". He was not shivering physically at this point. The sat monitor taking so long to work, the thermometer not working, the finger stick (i used the word stick for you Dwayne) that I had difficulty getting anything out of... Because he didn't feel cold to me, I wrote off the rest to equipment malfunction. There was also a big concern about the lithium. That's what I was leaning towards for this call. Sometimes, machines don't lie. 1
Curiosity Posted October 20, 2012 Author Posted October 20, 2012 I was told later it was a tumor in his brain stem that was affecting his thermoregulation.
DwayneEMTP Posted October 20, 2012 Posted October 20, 2012 This was a great scenario! I think the tumor was caused by CO poisoning though...just sayin'....very common... 1
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