Scaramedic Posted May 27, 2006 Posted May 27, 2006 :shock: Wow Rid! I would have just said a change in BP and/or a dropped radial during inspiration, but damn! No provocation/palliation with that upper thoracic pain right? I always over think these scenario based things. :roll: OK so what do we do, well lets start with "we care" oxygen, 2L NC. IV, monitor/12 lead. Anything interesting on that 12 lead? Peace, Marty :thumbleft:
ERDoc Posted May 29, 2006 Author Posted May 29, 2006 :shock: Wow Rid! I would have just said a change in BP and/or a dropped radial during inspiration, but damn! No provocation/palliation with that upper thoracic pain right? I always over think these scenario based things. :roll: OK so what do we do, well lets start with "we care" oxygen, 2L NC. IV, monitor/12 lead. Anything interesting on that 12 lead? Peace, Marty :thumbleft: Nothing makes it better or worse. 12 lead is unremarkable. O2 on and no change in pain status. "Hey, my left foot is starting to feel a little funny."
JPINFV Posted May 29, 2006 Posted May 29, 2006 Any visual differences between legs? Equal pushes? On any medications?
chbare Posted May 29, 2006 Posted May 29, 2006 ERDoc, any Hx. of syncope or hoarseness following the accident? Are there any peripheral pulse deficits noted? Is the patient able to describe the sensation to her left foot? Lower leg motor weakness noted? (foot dorsiflexion, great toe extension, and foot plantarflexion?) DTR's intact? Babinski's reflex? Take care, chbare.
ERDoc Posted May 29, 2006 Author Posted May 29, 2006 There are no visual differences in the legs. Pt can push and pull equally on both sides. Only med is a beta blocker for her htn. There is no h/o syncope. DTRs and babinski intact. Great question about hoarseness, but there was none. The pt says the best she can describe it is like pins and needles starting. The left DP and PT pulses seem to be decreased compared to the right. VS now 180/102 106 16 100% on NC
chbare Posted May 29, 2006 Posted May 29, 2006 Elevated B/P and back pain with Hx of HTN and S/P MVC raises flags regarding complications from an aneurysm (hence the questions), however, I cannot rule out a possible vascular obstruction at this point in time. I opt for hasty transport and initiating 2 lines at TKO with continued freq V/S monitoring, O2 therapy, and continuous cardiac telemetry. Progressive EMS?? Take care, chbare.
ERDoc Posted May 29, 2006 Author Posted May 29, 2006 Elevated B/P and back pain with Hx of HTN and S/P MVC raises flags regarding complications from an aneurysm (hence the questions), however, I cannot rule out a possible vascular obstruction at this point in time. I opt for hasty transport and initiating 2 lines at TKO with continued freq V/S monitoring, O2 therapy, and continuous cardiac telemetry. Progressive EMS?? Take care, chbare. How progressive do you want to be?
chbare Posted May 29, 2006 Posted May 29, 2006 ERDoc, are labs, (CBC,CMP,PT,PTT,INR,T&S) Xray, venous Doppler ultrasound, and CT available, or should I be focusing on a better physical exam? Consider IV beta blockers for the elevated B/P. Take care, chbare.
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