Memorable Misdiagnosis

[Laura Anne]

SO, the point of this post is for everyone to fess up their tunnel vision call(s) of the past. MIND YOU, please do nt post anything criminal.....ugh. Be professional and use this as a learning tool, tool.

Once upon a time, I had a patient who was unconscious lying bent over backwards on a large pipe. He was power washing the floor in a closed little building that was part of the electrical company. He was agonal resps, soaking wet, and quite flushed in color. After finding out if the power was still or not, he was removed to the outside and given high flow O2 via BVM and immediately increased his LOC. By the time the medics got there, he was CAOX4 and C/O a severe H/A.

Yep...my thought process? He got electrocuted while standing in a puddle of water with this machine he was using to clean the place.

Real deal...the power washer was gas powered. CO. *sigh* :roll:

Moral of the story: everyone tunnel visions and makes mistakes, but it's how we learn from it that makes the difference.....oh and if we didn't kill someone in the process. :shock:

[katbemeEMT-B]

We had an elderly lady with a vast med. hx. Her SAT was quite low, low BP, slow cap refill, low grade temp, and gray in color. Our first thought was she had a pneumonia as she had just had abd. surgery. The lungs were clear. We put her on O2 and loaded her and went. En-route we started an IV site, checked blood sugar, and vitals. She soon became more lucid. In the less than five minutes it took to get to the hospital she was now holding conversation with us and describing her surgery. Two days later a family member approached us and informed us that her mother was doing much better. She said that mom's body had shut down due to CO. We asked her what from as it was summer and nothing was running in or near the room. She said it was from taking Hydrocodone. That was an eye opener. :cyclopsani: It also made me rethink the fact that my child had just been prescribed the same thing for a tib/fib fracture. We took him off it. Another life lesson learned.

[VentMedic]

A few month ago a very memorable CO incident occurred in Key West at the Doubletree Hotel. At first it was contributed to boating and exhaust fumes until a death was reported. The hotel boiler was at fault.

http://www.redorbit.com/news/health/784137...source=r_health

Different pulmonary diseases show elevated CO levels.

http://www.chestjournal.org/cgi/content/full/125/6/2160

General sources including endogenous;

http://www.mcsrr.org/resources/articles/P11.html

[spenac]

Sorry to leave the CO talk. Young young young small girl. Nausea, sharp pain abd. Didn't fully match any particular abd problem, could not fully dismiss several problems. Denied being sexually active when asked if she could be pregnant. Transported with unknown abd pain. In monitoring the pulse and respirations enroute to the hospital noticed reg pattern changes occurring. Had clothing removed, delivered a baby just seconds after removing clothing. Still denied sexual activity, miraculous conception I guess.

[katbemeEMT-B]

Sorry to leave the CO talk. Young young young small girl. Nausea, sharp pain abd. Didn't fully match any particular abd problem, could not fully dismiss several problems. Denied being sexually active when asked if she could be pregnant. Transported with unknown abd pain. In monitoring the pulse and respirations enroute to the hospital noticed reg pattern changes occurring. Had clothing removed, delivered a baby just seconds after removing clothing. Still denied sexual activity, miraculous conception I guess.

Were mom and baby okay?

I love it when these young girls deny that they are sexually active and turn up pregnant. I am a prepared chidlbirth instructor and have had a few of those come through my class. I asked them, "If you're not sexually active why are you in a class for expectant mothers?" Their response, "My doctor suggested it would help me." I would then ask, "So you have never had intercourse?" "Nope, we came close but he never put his thing in me." Hello little girls!!

[spenac]

Were mom and baby okay?

I love it when these young girls deny that they are sexually active and turn up pregnant. I am a prepared chidlbirth instructor and have had a few of those come through my class. I asked them, "If you're not sexually active why are you in a class for expectant mothers?" Their response, "My doctor suggested it would help me." I would then ask, "So you have never had intercourse?" "Nope, we came close but he never put his thing in me." Hello little girls!!

mom fine baby no lived only few hours once at hospital, premature, those are the hard ones.

I always love the little girls "it's not mine" statement when I've got a baby thats still attached to the undelivered placenta, makes me look under the sheet to make sure theres not another girl hiding under there.

[paramedicmike]

Ok. I gotta ask. How does hydrocodone affect Carbon Monoxide (CO) levels in a patient?

I can't find anything that supports this idea. Can some help enlighten me? Or was there just some mistyping going on above?

-be safe

[Dustdevil]

There have been quite a few patients over the years who left me wondering WTF was going on with them. However, I can only recall one specific incident of actual misdiagnosis, and that was just a few months ago.

Early thirties foreign male who spoke essentially no English, except for a few words, making history taking difficult at best. Presents complaining of severe facial pain in the maxillary region. No individual teeth were loose or tender to tap, nor were there any obvious cavities or other dental problems. He had headache, nausea, spiking fever, loss of energy and appetite. Sinuses were inflamed and mucous was green and purulent. Sinus x-ray clearly showed a consolidation in the Lt maxillary sinus region. No brainer, right? So I put him on Augmentin and Vicodin and sent him on his way.

Two days later I get a report that he was taken to dental, where they cut him wide open for a maxillary dental abscess. :shock:

Yeah, I know that was an easy mistake to make. And I'm not the last person who will make that one either. But damn, that is embarrassing! :?

[katbemeEMT-B]

Ok. I gotta ask. How does hydrocodone affect Carbon Monoxide (CO) levels in a patient?

I can't find anything that supports this idea. Can some help enlighten me? Or was there just some mistyping going on above?

-be safe

Don't know. I'm not a doctor. That's what he said. I can see if I can find some info for you but it will take some time as I am working the next several days.

[medic001918]

Ok. I gotta ask. How does hydrocodone affect Carbon Monoxide (CO) levels in a patient?

I can't find anything that supports this idea. Can some help enlighten me? Or was there just some mistyping going on above?

-be safe

I was wondering the same thing myself.

Shane

NREMT-P