Kaisu Posted October 20, 2012 Posted October 20, 2012 Dwayne is correct - that was a very nice scenario. Well presented. Do not feel bad for missing it on the scene. There was very little you could have done to warm that patient. And thank you for an informative and educational first scenario.
Eydawn Posted October 20, 2012 Posted October 20, 2012 Personally, with the weakness and whacked out affect, I was thinking he ate dear old departed Mom's lithium caps. Whoops! Look! A zebra! Isn't it purdy? ;-) Sometimes it's the darndest things, and there's no way to tell until the right person goes 'waitaminute...' on something. News flash- even after we get them in the hospital, sometimes we can't figure out WTF caused XYZ- period. Not with all the labs in the world, not with the greatest workup, and 5-6 different sets of MD eyes plus countless RNs and CNAs... sometimes, it remains in the great unknown. I wonder, with the brainstem compromise, if active warming would have helped because he was already in a hot environment and profoundly cold despite that. Hm. Any thoughts? Wendy CO EMT-B RN-ADN Student
Arctickat Posted October 20, 2012 Posted October 20, 2012 Pericarditis!!?? Dementis??!! GI Bleed??!! Now you know why I don't participate in these things. I suck. :'( 1
Arctickat Posted October 21, 2012 Posted October 21, 2012 I suck, I suck, suck, suck suck suck...and blow..I blow blow blow at my job. Just for you Dwayne.
systemet Posted October 21, 2012 Posted October 21, 2012 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. I've been caught by hypothermia before, as well. Especially if you're used to working in cold climates, when you have someone in a relatively warm environment, it's easy for hypothermia to slip down your list of differentials. Surface temperature depends more on peripheral blood flow than on core temperature. [i don't have a source for this, but I'm pretty sure I could find one]. The human hand is a very insensitive device for measuring temperature. I think someone suggested on another thread recently, that if you pour three big bowls of water, one from the cold water tap, one lukewarm, and one that's fairly hot to the touch, place you hands in the hot bowl and the cold bowl for a minute or so, then plunge both into the lukewarm bowl, you get the sensation of warmth in one hand, and cold in the other, despite them both being exposed to the same temperature. We often respond more to changes, and differences, than to absolute values. If you've not been given appropriate equipment to take a core temperature, then obviously it's hard to know what it is. Often we lack any equipment for taking a temperature, or the equipment we have is horribly inaccurate, or only works in a narrow range. If you don't have the ability to do a core temp, then the nurse giving you a hard time about not identifying the hypothermia might as well be complaining that you didn't know his T4 level was low, or that he's hypophosphatemic or something. Even here, if you know this patient is hypothermic, you're limited in what you're going to be able to do about it. You're pretty much restricted to preventing further heat loss at that point, and now know that you need to be fairly gentle in moving/handling them, and that your drugs may not work until the patient warms. It sounds like this guy was still compensating fairly well, despite the hypothermia. He's not that altered, he's not particularly brady, and while you can be very hypothermic without Osborne waves, etc., he doesn't have any ECG changes. I wouldn't feel too bad. 1
island emt Posted October 21, 2012 Posted October 21, 2012 Well said systemet: thats what led me to ask about the core temp. Hypothermia is a very under diagnosed illness . It is easy to overlook it and the subtle signs of the process. after having been bit on the arse a few times, we learned to be highly suspect when things just don't seem to fit the picture. A 65 degree day can give you a severely hypothermic Pt. even though they are dressed appropriately. and not out in the air. To you or I it seems like a day to go for a nice walk to the beach. Decreased peripheral circulation and lack of physical activity add to the problem and begin the cascade effect. I purchased a hypothermic thermometer for just this reason.
Curiosity Posted October 21, 2012 Author Posted October 21, 2012 The hypothermic patients I come into contact with usually have an obvious reason for it. They're outside, poorly dressed, fell in cold water...I never would have thought hypothermia in someone who's been in a hot house for days. I've learned a valuable lesson from this call. Sometimes it's what's not there that gives you the answer. Ie: not feeling warm to the touch, not able to get a reading on the thermometer. 1
Kaisu Posted October 21, 2012 Posted October 21, 2012 its all learning. I know it hurts when some nurse gives you the gears. Gotta have a thick skin in this business. All in all, its a big win and you made it that way: 1 by learning the lesson and 2 by posting here so others can learn too. Props to you. 3
Arctickat Posted October 22, 2012 Posted October 22, 2012 unless the temp in the house is 98.6° their core temp can always drop.
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