ERDoc Posted March 13, 2007 Posted March 13, 2007 It seems as if it has been a while since there has been a good scenario so I felt compelled to come up with one. Put on your thinking caps kiddies (it is 4am so this might not be as difficult as I hope it is). You are called to the intersection of Urbut and Stinx for a man down. Anonymous caller states there is an unconscious male on the sidewalk. PD notifies you that the scene is safe. You arrive to find a 21y/o male with slurred speech and left hemiparesis. As I typically do, I ask you to keep your questions to the history only at this point. We will come back to the physical exam later. Happy hunting.
sledogg1 Posted March 13, 2007 Posted March 13, 2007 If this was early morning in ol Michigan he was jumped, hit in the temprol lobe resulting in a complex sz or CVA...........Oh, better check BGL because his glucose store are shot to hell.
rocket Posted March 13, 2007 Posted March 13, 2007 In what position/posture was the patient found? Is there anything remarkable that you or PD observes in the immediate area surrounding the patient? Basically I'm just trying to collect a few clues about the big picture here. *EDIT* Oh and uhhh...what is the patient's overall appearance (dress, etc) and does the patient appear to be a viable historian; in other words, can he tell us what happened, if the hemiparesis is new, etc. Thanks for the scenario! -Trevor
ERDoc Posted March 13, 2007 Author Posted March 13, 2007 The pt is just outside a bar in early Sept. He is wearing a fraternity shirt and nice pants. He APPEARS intoxicated. He just laughs as you ask him questions, though he will answer yes/no questions. BGL is 156. When you ask him if he has ever had the paralysis before he tells you no.
Quicksilver Posted March 14, 2007 Posted March 14, 2007 SAMPLE / OPQRST please Cinn. Stroke Test to check R/L side differance Someone else please get baseline vitals. Thanks
Quicksilver Posted March 14, 2007 Posted March 14, 2007 You said yes/no questions didn't you, I am paying attention. I would get some paper and a pen and ask him if he feel if he could write down answers for me. Q) Do you feel okay? Q) Do you have any allergies? if nodding yes can you write them down for me... Q)Are you taking any meds again please write them down and when you last took them Q)Did you have anything to eat while at them bar? more writing.. Q) Did/do you have a headache?
sledogg1 Posted March 14, 2007 Posted March 14, 2007 Frat boy outside bar in Michigan SW..........i stick to my reply
emt322632 Posted March 14, 2007 Posted March 14, 2007 What happened prior to his paralysis? Was he actually drinking, or is this just a case of wrong place wrong time? (Could have been picking a buddy up but doubtful lol) Any history of trauma? Any medical history? Meds (legal or illegal)? related syncope? incontinence? history of sickness? Let's get some vitals and get some O2 on this guy, considering him a priority transport is probably not a bad idea, IV and monitor as well... Oh also...any family history of stroke, seizure or any other good stuff? (Diabetes, heart problems, any other neuro disorders?)
rocket Posted March 14, 2007 Posted March 14, 2007 What happened prior to his paralysis? Was he actually drinking, or is this just a case of wrong place wrong time? Exactly. I understand the call came in anonymous but that does not mean there is not someone in the immediate vicinity that can tell us a bit more about the situation. If PD is still present and/or the scene appears to be managed appropriately I would like someone to step into that bar/surrounding businesses/question bystanders to see if there is any more info available to us. If I am the lone first responder then obviously this won't happen but if I am here with a crew then let's make use of them. We have a patient that may or may not be an accurate/helpful historian and although there is no real way to verify the original caller's claims the issue was originally reported as an unconscious male on the sidewalk. Maybe this patient has had a recent change in level of consciousness...or maybe not. I have some exam/intervention things I'd like to do but in keeping with ERDoc's request I'll stick it mostly to history right now save for one. I'm interested to hear this patient's responses to Quicksilver's questions. While we are asking these questions hows abouts we slip a shoe off of the affected side and give a little upstroke with the trauma shears against the sole of the foot. Is there any response to this stimulus? -Trevor
chaser Posted March 14, 2007 Posted March 14, 2007 He APPEARS intoxicated... Can you smell AOB or he merely appears intoxicated by behavior and speech?
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