Case Study: Leg Pain

[OVeractiveBrain]

Connecticut may be strict as all hell about underage drinking, but thank god they are liberal when it comes to their medics. In New Haven, Yale-New Haven just swapped over to a "dont call us" policy. While you still CAN, theyd prefer you not, unless you have a full trauma (trauma with AMS) or a CVA mandating fibrinolytics (of which very few a actually do). It is amusing to walk through the door with a 79 year old female complaining of slurred speech that has resolved itself after a TIA a week ago and watch the nurse scream at you for not calling in a stroke team. That is, until teh doctor comes over and says "oh, ok. No, no Stroke Team." I get to look at the nurse with those "told you so" eyes. Owned.

Here where I am in New Orleans they are moving towards New Haven Protocols. Everything is on standing order. In connecticut, the only thing I had to call for was administration of a benzo to sedate a combative patient. And even in that case I didnt HAVE to, the docs usual just sign when I get there. Most other benzo uses were standing.

Only the Volley Services (Stratford, for example) which is a medic service, has to call for orders for everything. Adenosine? Call. Amio? Call. GLUCOSE? Call. Thats also the way Louisiana (especially New Orleans and the surrounding area) has been. Only now do they have standing orders for everything. Looks like i got down here just in time.

I would probably take the 20 mg of Morphine and a couple 100 mg of lidocaine and inject myself if I had to call for everything. While I suppose if you developed your career under those conditions you would be used to it, I was (and am) very appreciative of services where they give the decision making skills to the paramedics, and let them make those calls.

[captainstandup]

I would be curious if he has been in a really hot environment that led to sodium or potassium depletion. Beyond that exposure to spider bites or envenomation by a "creepy crawly" vector. Overuse of antacids or ASA or taking prescription meds not prescribed to him. I think pretty much else has been covered.........

[Dustdevil]

Definitely one of the better, more eye-opening case studies ever posted here. :thumbright:

[fiznat]

I would be curious if he has been in a really hot environment that led to sodium or potassium depletion. Beyond that exposure to spider bites or envenomation by a "creepy crawly" vector. Overuse of antacids or ASA or taking prescription meds not prescribed to him. I think pretty much else has been covered.........

Not that I know of. It is starting to cool off up here, so even people without A/C (most everybody in the poor sections like this one) are fairly comfortable temperature-wise. I think the 'lyte depletion is pretty much all from the extremely frequent urination secondary to his increased BGLs. He told me he was draining the lizard at least once an hour or so, and this has been going on for a week!

Definitely one of the better, more eye-opening case studies ever posted here. :thumbright:

Thanks dusty!

[Medic26]

Yes, Thank you for this unique case.