dahlio Posted November 1, 2007 Author Posted November 1, 2007 He passes the stroke scale fine. No facial droop, equal grips, push up/down on feet is good, and is easily understandable. He'll follow commands eventually after constant repetetiveness. As stated before, ALS does BGL and gets 104. He's sat'ing at 99% on 15L NRB, didn't get a number before he was placed on NRB. Like I said, not a scratch on him, except for the ankle. No evidence of a postictal state.
ERDoc Posted November 1, 2007 Posted November 1, 2007 Tell us a little more about the ankle. Is it red, warm or tender? Any other abnormal joints? How are DP/PT pulses? Any visual problems?
tylerd123 Posted November 1, 2007 Posted November 1, 2007 Okay, observing the ankle.... Look for any puncture marks, cuts, ingrown toenails, etc....if infection has set in, sepsis could have occurred. I didn't see the temp of the pt., but not all people with sepsis have a high temperature. Look for pus-filled areas, green areas, red/pink streaks. One of the problems I see with this being sepsis is the fact that his blood pressure is so high. The majority of time, with septic pts, is that their b/p is usually lower than normal.
tniuqs Posted November 1, 2007 Posted November 1, 2007 Any fanged vipers around or is this patient a collector of armpit-less slithery things ? I think I see where ERdoc is going with this...Septic arthritis perhaps or DVT that is kicking of micro emboli ... or worse....... but no signs of SOB or Dyspnea, is that correct ? cheers
ERDoc Posted November 1, 2007 Posted November 1, 2007 Any fanged vipers around or is this patient a collector of armpit-less slithery things ? I think I see where ERdoc is going with this...Septic arthritis perhaps or DVT that is kicking of micro emboli ... or worse....... but no signs of SOB or Dyspnea, is that correct ? cheers Actually I was thinking of more exotic thing than DVT and septic joints. I hear zebras in this case so I was looking at envenomations and atypical neurosyphillis. Give me a while and I am sure I can come up with a few more bizzare ones. Has this pt ever been exposed to bat guano or does he own a flea and tick farm?
dahlio Posted November 1, 2007 Author Posted November 1, 2007 No difficulty breathing. The ankle is tender, and pale. Distal Pulse is not present. The pt. has a hard time following your finger when it's to the left of him. He's still asking the same questions over and over again.
tniuqs Posted November 1, 2007 Posted November 1, 2007 Ah the old neuro-cryptosporidium senario...that's the 2nd time I fell for that one ! argh I hate when that happens ! So any nystigmus present ? Seeing as were headed towards an assessment of Cranial Nerves next.
tniuqs Posted November 1, 2007 Posted November 1, 2007 One of the problems I see with this being sepsis is the fact that his blood pressure is so high. The majority of time, with septic pts, is that their b/p is usually lower than normal. In septic shock low b/p is a late sign and rather ominus as well, don't think were headed down that road just yet ..... I hope. :shock: But if he keeps asking the same question over and over ...he just may sustain a new head injury, not coup contra coup... but BLUNT TRAUMA from my 3 cell.... j/k.
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