Tetany

[AnthonyM83]

Ohhkay, that makes it completely clear now. When I read that it alters albumin binding, I assumed it inhibited it (like so many other proteins in low pH) and so it didn't match up with the intra/extra cellular calcium levels listed in the articles.

So, I'm guessing that's one of the ways blood calcium level is regulated... by binding/unbinding with albumin.

[AnthonyM83]

Seems like most bindings could follow that model? Cause really it comes down to Bohr/Haldane being a reflection of the classic factors that affect chemical reactions (temp, concentration, catalysts/medium(pH), physical state).

[tniuqs]

Lets put this in realistic terms for giggles shall we?

Your called to a residence....possibly ??? a classic carpopedal spasm associated with hyperventilation.

So just how does one treat this in the field ?

Are there any presenting signs that may indicate this is your working DX ?

Are there any possible differential DX that could be serious factors in your treatment ?

squint scratches balding head......

[AnthonyM83]

The way I do it, in practice:

The age, race, and gender of that patient are my first clues as I'm walking up to them. The most common profile (based on our area and the calls I've seen) seems to be female in her teens 20s, but through their 40s, almost always hispanic/latina. No obvious suspected medical problems upon first glance (obesity, on a nasal cannula, obviously disabled, cyanosis, obvious lung sounds heard on approach). Often, there are family members who are very "excited" too.

Once we make contact with patient, one person tries to talk to patient, calm her down, refocus their attention, remove them from the excited family members, coaches them on slowing their breathing, provides a steady voice, and lets them know that their contracted hands and feet are 100% normal when hyperventilating, they're not getting worse, they're not going to die, it's going to wear off as soon as they slow their breathing, explain the concept of having too much O2 and that it's actually causing it, and that as medics all we can do is try to calm them down, but their outcome is 100% in their hands, so they have to force themselves to slow it down.

As they become able to answer your questions, you ask about their history, find out of an emotional even just happened, other medical problems, medical hx, hx of the same, any other complaints. Your partner is concurrently interviewing the family/friends/significant other and explaining that they must all calm down so that she calms down and gets better. Explain the hyperventilation syndrome to them too.

Then you basically just wait to see if patient's condition improves on the spot. Then LA County FD jumps in and asks what hospital they want to go and you've got yourself a one hour BLS call and patient gets an ambulance bill and gets kicked out to the lobby at the hospital, so they have usually go home.

At least that's how we do most of ours.

Differential diagnosis for hyperventilation are huge, but so that's where history comes in...immediate hx, what was going on during the onset, past medical hx, patients current mental state and physical ability, any other complaints, and waiting to see resolution of event after "calming and coaching measures". You want to make sure it's not a trauma, side effects of medicine or drugs, complication of other medical problems they have, not cardiac, not stroke related, etc.

Most of this comes from general impression, though...different types of hyperventilation TEND to look different. But just in case, you do your history/assessment etc.

[Dustdevil]

The most common profile (based on our area and the calls I've seen) seems to be female in her teens 20s, but through their 40s, almost always hispanic/latina.

Must be a Kalifornia thing. In Texas, it is mostly black females in their late 60s or usually 70s, in the front pew of a Baptist church, and the preacher standing over her, screaming into a PA microphone for God to cast the demons out of her, and the rest of the congregatation repeating, "HOLY JESUS! HOLY JESUS! HOLY JESUS!" over and over the whole time.

And, of course, you can never get a no-ride out of the deal because of their age. :?

Firemonkeys must be different in Kalifornia too, because in Texas they no-ride everybody. Even the actual AMIs. :roll:

[tniuqs]

The way I do it, in practice:

The age, race, and gender of that patient are my first clues as I'm walking up to them. The most common profile (based on our area and the calls I've seen) seems to be female in her teens 20s, but through their 40s, almost always hispanic/latina. No obvious suspected medical problems upon first glance (obesity, on a nasal cannula, obviously disabled, cyanosis, obvious lung sounds heard on approach). Often, there are family members who are very "excited" too...........

Your quote is edited for brevity.

Anthony: Without a shadow of a doubt I must say you are one of the most refreshing individuals that I have had the pleasure to meet in this venue, Your zeal for information is simply astounding, and you call yourself a perpetually EMT, kudos, so many can learn from your in attitude and vigour. You ask difficult questions consistently and this is the true spirit of a professional. I just feel that this must be stated, you are well on your way to becoming an excellent practitioner as a Paramedic... if I ever have the pleasure of a ride along on your truck (and I do intend to visit some day) I would be my honour.

Differential DX:

Hey don't get caught with your pants down, ever, because I have !

1- Central Neurological Hyperventilation in a 24 year old female with a sub arachnoids haemorrhage.

2- A 21 year old female with a fractured T 12 transected spinal cord from an unknown cause.

DON'T ever hang your hat on a demographic "likelihood" when hyperventilation syndromes present.

cheers

Google Midwifes sign, if you see this its a really good indication of carpopedal spasm is associated with hyperventilation, but always look for the underlying cause.

[AnthonyM83]

Thank you.

And yes, you have to be careful, that's why you wait to observe resolution of he episode (along with your pt interview/hx/assessment).

Dust, we get those too sometimes, but not as often and they usually do the hyperventilation and faint bit rather than the hyperventilate and cramp bit....not sure if that's an age thing... FD transports most for fear of liability (*cough*poorconfidenceinskillsandassessments*cough). We've had a teenage girl c-spined for muscular non-midline neck pain resulting from swimming. No trauma. ER always flips out, but they never do anything about it.

[Eydawn]

Ok... not seeing anything associated with midwives sign on google... not to mention that my enter and apostrophe keys on the laptop have gone kaput! Someone post it in here for us? I am dying to know what it is! Wendy CO EMT-B

[tniuqs]

Also known as Trousseau's sign, sometimes called "midwife's sign" for the classic presentation as its very similar to the hand position when doing an interpartal assessment, so try googling hypocalcemia, no apostrophe key needed.

cheers