Numb foot

[Jaymazing]

How's his respiratory status? (Rate/quality/Air entry/Sp02)

Circulatory Status? (Heart Rate/BP/ECG/Skin Condition)

What's his temp? Is the temp going up, or coming down? Any rash?

How 'slightly' are the WBC elevated?

Has he ever had chicken pox? Herpes? HIV? Vaccinations?

Any out-of-country travel in past 3 months?

I'm going to initiate infectious precautions (Droplet at the very least)....

Hows the rest of his neuro exam?



This is fun!

Edited April 16, 2013 by Jaymazing

[mobey]

How's his respiratory status? (Rate/quality/Air entry/Sp02) Air entry is clear, with increased nasal mucous production. Rate 14/min. Sp02 99% room air

Circulatory Status? (Heart Rate/BP/ECG/Skin Condition) HR 98 prior to morphine, 76 now. BP 174/90 ECG = sinus rythm. Skin looks healthy, no rash/trauma.

What's his temp? Is the temp going up, or coming down? Any rash? He came in with a slight temp (38.6) but it has subsided (37.2) He had tylenol the day prior

How 'slightly' are the WBC elevated? I'll be honest... I don't have the exact figures with me, but it was marginal.... Not Holy shit

Has he ever had chicken pox? Herpes? HIV? Vaccinations? Yes, No, No, Not since school

Any out-of-country travel in past 3 months? Now you sound like a nurse at the U. Hahaha No

I'm going to initiate infectious precautions (Droplet at the very least).... I like your style, I hate flu season, and man colds have been deadly!

Hows the rest of his neuro exam? Glad you asked! With enough poking and prodding you find the entire posterior portion of his right leg seems to be nearly totally numb. Every other exam is completely normal though.

So.... As you begin to load this guy onto the cot via "Slide yourself over buddy"... He suddenly voids his bladder in his pajamas.

"holy Sh*t, I didn't even know I had to go!!"

He is super embarassed, and swears he felt nothing... he just sees the urine and puts 2 and 2 together.

[Jaymazing]

My partner wants to know if he has any tick bites.

I notice a change! reassess LOC-A-B-C.

Reassure him, "it's okay, that's why we have disposable sheets", and keep him comfortable.
Anything remarkable about the urine? (Blood? strong odor?) ...other than it being a surprise (and adding to the work load of my partner, who will be cleaning)

I want to keep doing repeat neuro's on this gentlemen, to rule-out or rule-in any ascending paralysis/neuropathy or further acute changes.

Is his lumbar pain midline, lateral, or flank?

Was there a diagnosis on his old back injury? any disc herniation or #?

Any family Hx of peripheral neurological disease?

[mobey]

My partner wants to know if he has any tick bites.

I notice a change! reassess LOC-A-B-C.

Reassure him, "it's okay, that's why we have disposable sheets", and keep him comfortable.

Anything remarkable about the urine? Nope, seems normal

Is his lumbar pain midline, lateral, or flank? Starts in the buttox and shoots down his leg. The other pain is a constant midline described as "From my hip to my tailbone" he will not let you palpate or touch his back.

Was there a diagnosis on his old back injury? any disc herniation or #? Unfortunatly he only had a single x-ray which his family doc looked at and said it was normal.

Any family Hx of peripheral neurological disease? No

Oh: and no tick bite, with or without associated Halo

Edited April 16, 2013 by mobey

[Jaymazing]

Well, hmmmm. Does the pain go away when he lies on the unaffected side?

Does he have an IV still? If not, lets have one.

Also, lets try to keep him from exerting himself or moving too much if possible.

Any N/V/D? Any problems with urinating/BM prior this?


I hope his scooching over didn't aggravate anything...

[Aussieaid]

Any chance it's Cauda Equina Syndrome caused by a local infection? Maybe from Staph? Probably not though, with the more systemic symptoms....

[mobey]

Any chance it's Cauda Equina Syndrome caused by a local infection? Maybe from Staph? Probably not though, with the more systemic symptoms....

Bing!

Right diagnosis, wrong cause.

The original injury caused a bulging disc which was not seen on X-Ray by the family Doc.

Simply moving the wrong way recently started an inflammitory process which resulted in cauda equina syndrome.

The fever is from influenza.

I initially thought GBS as well, however I was not convinced when there was only one limb affected..... Once he lost control of his bladder, and most importantly, felt nothing with urination - Cauda equina moved to the frontline.

I'll let someone who has never heard of the syndrome before find some articles to link here.

Thanks for playing!!

[Jaymazing]

http://en.wikipedia.org/wiki/Cauda_equina_syndrome

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082683/

Hakuna Matata Syndrome! I should have known

[HellsBells]

Thanks a lot Mobey, now I feel like a real dumb paramedic, this scenario already had be brushing up on GBS, and now, bam Cauda Equina Syndrome, which I'm not familiar with at all!

[mobey]

Don't feel bad Hells, I learned about it on Facebook so it is no doubt you had never heard about it

j/k

I actually learned about this on this forum, I think it was back in the days when Paramedicmike posted scenarios.

This is the 2nd case I have seen prehospital.... funny since I work rural, and don't have nearly as many calls under my belt as my urban counterpart. Either way, luck of the draw with these rare cases in North America.

BTW: Jaymazing: I almost had to Cyberslap you for linking Wiki, I was glad to see an ncbi link alongside it.

I remember back in the day someone using Wiki as a cite and a member here (I think Spenac) went into Wiki and changed the entry in the link to something sarcastic just to show the new member how easy it is.

All yu have to do is start a Wiki account and you can edit any entry, that's why you will not see it cited in credibal medical informational sources. I can appreciate that it is a decent place to start when you have NO IDEA what the illness is.... as long as those reading know that Wiki is only opinion.... not fact.

Thx for playing everyone!

Edited April 18, 2013 by mobey