MikeEMT Posted December 19, 2012 Posted December 19, 2012 I would say gastroenteritis. He was just jogging so that could explain his RR and HR findings...especially if he is new to jogging. I want to ask what supplements is he taking. What does his diet consist of? How often does he rehydrate? You said he had explosive diarrhea, how much was there? That could explain the low BP since he is losing fluid. Did pain subside after BM?
HarryM Posted December 19, 2012 Author Posted December 19, 2012 (edited) Nil supplements. No abnormal diet (healthy eater and stays away from saturated fats). He has had 2L of water today which is his usual intake and he jogs 10km 3x per week. BM was moderate, standard size BM apart from it's wateriness and uncontrollability and only 1. Pain did not subside after it and patient still feels like he needs to make another BM but is able to hold it in. It's not gastro While all the questioning occurs: BP drops of 75/55, HR drops to 100/min and RR increases to 40. Edited December 19, 2012 by HarryM
MikeEMT Posted December 19, 2012 Posted December 19, 2012 (edited) Sounds like he is going into shock. Spontaneous GI bleed? Internal Bleeding? Any Recent surgery? Is he Anemic? Is he African American (Sickle Cell)? Toxic Shock? Though the symptoms don't match up a muscle strain can cause diarrhea if the diarrhea was bad enough could possibly cause the other signs and symptoms. Doesn't explain the dizziness though. Heat stroke? I'm guessing here now Edited December 19, 2012 by MikeEMT
fakingpatience Posted December 19, 2012 Posted December 19, 2012 I don't like that his HR dropped with the blood pressure, to me shows that he is not compensating as well anymore, could go very quickly into decompensated shock. I'd grab an extra person and begin transporting emergent to the nearest surgical center (provided it's not to far away). Large bore IV, fluid challenge to achieve radial pulses/ SBP ~90, getting ready to use pressor agents. Also be prepared for him to code. I'm thinking that he either ruptured an aneurysm, or has a major bleed of an abdominal organ. Is his abdomen still soft? No palpable masses? Would love to have an ultrasound... Again, what color was the BM? Any metalicy smell? If I carried fentanly I think I may consider that as well, to see if we can get the pain better under control to pinpoint its origin.
HarryM Posted December 19, 2012 Author Posted December 19, 2012 Sounds like he is going into shock. Spontaneous GI bleed? Internal Bleeding? Any Recent surgery? Is he Anemic? Is he African American (Sickle Cell)? Toxic Shock? Though the symptoms don't match up a muscle strain can cause diarrhea if the diarrhea was bad enough could possibly cause the other signs and symptoms. Doesn't explain the dizziness though. Heat stroke? I'm guessing here now It's none of these but you are on the right track with the S word. Dizziness most likely caused by sudden hypotension. I don't like that his HR dropped with the blood pressure, to me shows that he is not compensating as well anymore, could go very quickly into decompensated shock. Spot on with this....although consider what type of shock he could be in. His abdo is still soft with no masses. His BM was watery and runny but not an abnormal colour or smell. The patient vomits while you are there. No blood in the vomit. It looks normal. Very wild guess, Food poisoning! Nope
HarryM Posted December 19, 2012 Author Posted December 19, 2012 Treatments so Far: - Large bore IV: you get a 16G in an ACF when you first arrive but since his BP has dropped you can't get a second line - Fluid loading: after 1L you achieve a minor rise in BP to 80/60 but nil other vitals improve and patient condition doesn't improve - Fentanyl: to achieve any form of pain relief you'd need a minimum bolus dose of 50mcg - do you want to risk it?
Curiosity Posted December 19, 2012 Posted December 19, 2012 JVD? Difficulty breathing? Chest pain? Breath sounds? He's in shock. No signs of bleeds, the diarrhea wasn't enough to cause hypovolemia. No signs of neuro involvement, leaves mechanical. PE would be my guess with the increasing RR.
HarryM Posted December 19, 2012 Author Posted December 19, 2012 Nil JVD, SOB or chest pain. Lungs clear on auscultation. No stridor from upper airway. His RR is now slowing down. It's not PE.
fab Posted December 19, 2012 Posted December 19, 2012 Ruptured spleen? some sort of anphylaxis (any other signs for that?) To sum it up, he may be having some sort of inflammation, he's running right towards schock, massive, diffuse abdominal pain, diarrhoea. How is he neurologically? Especially leg movement, reflexes. He didn't actually lose control over bowel movement, simply couldn't hold it anymore? Consider spinal cord damage... although infarction or inflammation in that area seems fairly far fetched. Endocrinological changes, wouldn't really explain abdominal pain. How does he react to norepi or whatever you've got. I've actually had a patient with massive gall stones presenting with those kind of symptoms... What does the stool look like? Prior to giving him catecholamines, I'd risk pain management, how does he react?
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