ERDoc Posted December 20, 2006 Share Posted December 20, 2006 You are called to the residence of a 12y/o male. His parents called the ambulance because he noticed his hand were turning blue just prior to their call. What else about the history do you want to know? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 20, 2006 Share Posted December 20, 2006 History especially history of Raynaud's syndrome???/ Meds allergies last meal was he painting at all during the day? was he outside does he have anythign like a rubber band or something like that around his hands? Pain in his hands? what have they done for this so far? Vitals pulses in the wrists? Pulse ox Check cardiac monitor Transport to ER unless you call the ER and they say go to his doctor's office. But from what I'm reading if this is Raynauds, this isn't something that we can do anything about in the ambulance Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 20, 2006 Share Posted December 20, 2006 is he on any of these meds or has he gotten ahold of any of them and took them?? Amiodarone Certain medications Dapsone High nitrite ingestion Ingestion of nitrates Potassium chlorate poisoning I'm probably going to far in my posting and taking it to extremes but does he or his family have a history of any of these? Cyanosis as a symptom include: Atrial septal defect (ostium primum) Cirrhosis of liver Ebstein's anomaly Eisenmenger's syndrome Fallot's tetralogy Hydrogen sulfide Patent foramen ovale Phlegmasia alba dolens Pulmonary valve stenosis Transposition of great arteries Tricuspid valve stenosis Ventricular septal defect I'm really leaning towards this until more info is posted Posttraumatic Sympathicotonia and Raynaud's of the Hands Secondary to Thoracic Outlet Syndrome: The "Blue Hands" Syndrome Link to comment Share on other sites More sharing options...
ERDoc Posted December 20, 2006 Author Share Posted December 20, 2006 History especially history of Raynaud's syndrome???/ Meds allergies last meal was he painting at all during the day? was he outside does he have anythign like a rubber band or something like that around his hands? Pain in his hands? what have they done for this so far? Vitals pulses in the wrists? Pulse ox Check cardiac monitor Transport to ER unless you call the ER and they say go to his doctor's office. But from what I'm reading if this is Raynauds, this isn't something that we can do anything about in the ambulance Only history is asthma. When you ask about Reynauds the parents just give you a funny look and you take that as a no. Only takes albuterol prn. No allergies. Last meal was dinner at 6pm, nothing unusual (it is now 10pm). No painting. He was outside after school playing some football. No rubber bands or other form of tourniquet that you can see. No pain in the hands. The only thing they have done so far is worry and call you. We'll come back to the ohysical exam after all questions about the history have been completed. Link to comment Share on other sites More sharing options...
ERDoc Posted December 20, 2006 Author Share Posted December 20, 2006 is he on any of these meds or has he gotten ahold of any of them and took them?? Amiodarone Certain medications Dapsone High nitrite ingestion Ingestion of nitrates Potassium chlorate poisoning I'm probably going to far in my posting and taking it to extremes but does he or his family have a history of any of these? Cyanosis as a symptom include: Atrial septal defect (ostium primum) Cirrhosis of liver Ebstein's anomaly Eisenmenger's syndrome Fallot's tetralogy Hydrogen sulfide Patent foramen ovale Phlegmasia alba dolens Pulmonary valve stenosis Transposition of great arteries Tricuspid valve stenosis Ventricular septal defect I'm really leaning towards this until more info is posted Posttraumatic Sympathicotonia and Raynaud's of the Hands Secondary to Thoracic Outlet Syndrome: The "Blue Hands" Syndrome After you run that list of meds by the parents, they say that no one in the house is on any of them. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 20, 2006 Share Posted December 20, 2006 Ask the child if he got hurt in the spine/back during football and find out where he hurts. If he has pain in t7 or so then I'd suspect more strongly my last post. ok, how bout exam questions HEENT: exam shows? Neck: exam reveals Chest: exam reveals Back: exam reveals: Abdomen: exam reveals Pelvis: exam reveals Cardiac/resp: exam reveals GI/GU:exam reveals Extrem: exam reveals - are his fingers only affected or is it the entire hand? ask where did this cyanosis start - the fingers first or hands or did he notice? this is a biggie on the line of questioning in my opinion. Skin: cyanosis anywhere else? lips, ears, toes/feet? Link to comment Share on other sites More sharing options...
ERDoc Posted December 20, 2006 Author Share Posted December 20, 2006 Ask the child if he got hurt in the spine/back during football and find out where he hurts. If he has pain in t7 or so then I'd suspect more strongly my last post. ok, how bout exam questions HEENT: exam shows? Neck: exam reveals Chest: exam reveals Back: exam reveals: Abdomen: exam reveals Pelvis: exam reveals Cardiac/resp: exam reveals GI/GU:exam reveals Extrem: exam reveals - are his fingers only affected or is it the entire hand? ask where did this cyanosis start - the fingers first or hands or did he notice? this is a biggie on the line of questioning in my opinion. Skin: cyanosis anywhere else? lips, ears, toes/feet? It was a nice, leisurely game of two-hand touch (sorry to all of my non-American friends out there, I'm talking American Football (more cultural imperialism )). He did not hurt his neck or back. We will come back to the exam after all history has been taken. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 20, 2006 Share Posted December 20, 2006 ok PQRST SAMPLE Link to comment Share on other sites More sharing options...
ptemt Posted December 20, 2006 Share Posted December 20, 2006 You are called to the residence of a 12y/o male. His parents called the ambulance because he noticed his hand were turning blue just prior to their call. What else about the history do you want to know? Are his hands blue when you get there? Are they cold? It is cold here in Denver...........big blizzard. Link to comment Share on other sites More sharing options...
tniuqs Posted December 20, 2006 Share Posted December 20, 2006 Intermission time.....lmao @ (more cultural imperialism). :roll: 4 "Downs" is for poofters.... :twisted: Now back to your regular sheduled "Boy with the Blue Hands" senario. Link to comment Share on other sites More sharing options...
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