ERDoc Posted July 12, 2007 Posted July 12, 2007 So far I am not impressed with this hospital. How about a Foley? Did they at least check a chem 7. EMSGeek, when we talk about white counts, we generally leave off the thousands and just say something like 12.4 instead of 12,400. So, a nl WBC is 5-10. PS-This is my 1000th post! I have become a senior. Anyone want to go to the prom with me?
katbemeEMT-B Posted July 12, 2007 Posted July 12, 2007 Was she given any antibiotic therapy while in the hospital? If so, what was she given?
EMSGeek Posted July 12, 2007 Posted July 12, 2007 ERDoc: Thanks for the clarification. Congrats on the 1000th post. Is the patient's WBC considered elevated? Here's a breakdown of what I've gathered so far organized into the AEIOU-TIPS grouping. A: No evidence for alcohol. Husband was with PT and did not report anything. Nor do any of the physical findings indicate ETOH involvement. E: Endocrine/electrolytes are still a possibility as far as I can tell...cannot eliminate but nothing leading towards it. I: Condition existed while the BG was fine so I'd be comfortable removing insulin from the list. O: Same as ETOH, no reason to think opiates. U: Although the neurological symptoms of uremia line up with the patient none of the physical symptoms do. T: No trauma so I'm ruling this one out. I: I'm not sure what could cause a change in ICP outside of trauma so I can't really rule this one out. P: Poisoning could be a possibility just because it is such a general grouping. More blood tests would need to be run for any toxicological findings. Speak with the husband to determine if an exposure to any harmful substances could be possible. S: Nothing to indicate the patient is post-ictal so I'm ruling out seizure. Sepsis is a good possibility depending on what some of the other information shows. Ask husband about the patients activity in the last couple of days. Any travel, exotic foods, etc? I may be way off but I'm trying here....don't kill me, please.
katbemeEMT-B Posted July 12, 2007 Posted July 12, 2007 . PS-This is my 1000th post! I have become a senior. Anyone want to go to the prom with me? CONGRATULATIONS DOC!!! I would love to go to the prom with you. :flower:
chbare Posted July 12, 2007 Author Posted July 12, 2007 ERDoc, I will take you to the prom. My mother would be so happy if I hooked up with a Physician! Of course, there would be the minor issue of my wife. :-k You have your SMA-7: NA+: 130 K+: 5.8 CL-: 99 CO2: 20 BUN: 80 Creat:20 Glu:288 You place an 18 fr Foley without difficulty and note a scant amount of dark urine. I think the labs may help to explain the lack of a UA prior to your interventions. No rashes or joint pain. Pt has been dizzy however. Vital signs: R: 23 non labored, P: 105 regular, B/P: 178/98, SPO2: 95% on 2 lpm NC, Temp: 99.1. She received Levaquin 500 mg IVPB times 3 during her stay at the hospital along with her home meds. EMSGeek, ERDoc is correct regarding the labs. So, her WBC is a little on the elevated side. Just a side note for the new faces. This is more typical of my scenarios. Some of what will or has occurred may not actually occur in the world as we know it. You see, in many of my scenarios, we live and work in the magical land of Oz where bizarre and magnificent things can occur. More to the point, I try to set you up for a specific learning experience that would be difficult to replicate under typical circumstances. I want people to look at labs, Goggle, and really think about the physiology of the patient in question. Sure, this may not reflect reality; however, I hope the learning experience will help you in your practice as a provider. Now, where do we go from here? Take care, chbare.
EMSGeek Posted July 12, 2007 Posted July 12, 2007 I'm a BLS provider and assuming I'm on a BLS rig which has been requested to transport this patient I'm going to need to make a decision soon. I want to see what her vitals have been like for as long of a period as the hospital can give me. If the trend seems to be about stable I am going to request a paramedic to hop on board my rig in case the patient should have the nerve to croak but I'm going to take this transport. From a BLS point of view I may not be able to solve what is wrong with the patient and almost certainly I cannot fix it so the best thing I can do is to get the patient to a facility which can help her as quick as possible. Having the medic on board will allow better tracking of the patients condition, treatment of anything which may crop up, and a cushion should something bad happen. If I could not have gathered all the information which has been collected so far I would refuse the transport, give the hospital my EMT #, explain my reservations, and tell them to contact my supervisor. The initial report left way too many variables for me to even remotely comfortable taking the patient because at the end of the day I need to do what is best for the patient and keep the safety of my crew in mind. A patient with such a potentially serious condition needs more than my ambulance can provide during transport, suggest requesting a helicopter to take her out. Additionally with so little information I'd rather not take the slim chance that whatever she's got is contagious and expose my crew to it. I'm going to keep thinking regarding the scenario in terms of problem solving though.
chbare Posted July 12, 2007 Author Posted July 12, 2007 EMSGeek, do not think I will let you off of this case so easily. :twisted: In the land of Oz, provider level matters not. You will end up having to care for this patient and you along with all of the other participants of this scenario will produce a diagnosis. This is not about being an EMT-B, this is about solving a problem with your knowledge of physiology and research ability. Take care, chbare.
EMSGeek Posted July 12, 2007 Posted July 12, 2007 I'm definitely not tossing in a white flag. The medics and docs out there have too much fun anyway so there's no way I'm going to miss out. :wink: That was my definitive real world solution. I'm still abusing google trying to work out a few theories/possibilities.
chbare Posted July 12, 2007 Author Posted July 12, 2007 As I remember, there were medication lists and past medical history progress notes in the pile of paper work. :scratch: Take care, chbare.
EMSGeek Posted July 12, 2007 Posted July 12, 2007 Ok, what do those documents give us? Can I contact her primary care physician for a consult? Has she seen any specialists in the past? Any possibility of an autoimmune disorder such as lupus?
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