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Post by blueeighty8 on Mar 12, 2005 23:22:59 GMT -5
It is a wet rainy Saturday afternoon and you are dispatched out to a once vehicle MVA on Hwy. 80. You arrive on scene within 7 mins and you find a 21y/o female pt. standing with her hands on her knees. The vehicle, a 92 Exploder is parallel parked into some trees. Nothing major. You ask your pt. "Did you hit your head?" and she denies hitting her head and she does not remember the accident. But as she raises her head to speak to you she nearly falls backward as if to pass out. She also denies feeling sick, but then as you take her V/S she begins to vomit. Her V/S are P60 and regular R32, unlabored, BP118/85 Spo297% on outside air, skin is pale. S - Pt states that she appearently "blacked out" and does not remember the accident A- no known allergies M- OTC Excedrin for Migraines P- Pt. states that she has had similar episodes while at work, where she has "passed out" on the line, 3 or 4 times in the last 9 mos. The last episode was about 3 weeks prior to the MVA. But pt does suffer from Migraines L- Ate a bowl of Cheerios about 3 days ago, and has not had an appetite since. E- Pt. was under no stress prior to the MVA, episode "just happened". blood glucose: 210 The pt. refuses to be transported, and says she will just drive home and get some rest. What is your treatment, if any, and what is you dx??
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Post by Medic13 on Mar 13, 2005 6:17:43 GMT -5
Could be anything from an electrolyte imbalance, blood glucose, epilepsy, SVT, or even just a vagal response to the accident. Need more info.
By the way, your chemical one... I dunno. I'll let someone else take a stab at it.
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Post by blueeighty8 on Mar 13, 2005 16:48:38 GMT -5
No more info.. I just copied & pasted the scenarios from another site, just things that popped up on a search engine; you're on your own.
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Post by Medic13 on Mar 13, 2005 18:07:24 GMT -5
With the provided info, I guess I'll lean towards the blood glucose level... but I still have that "something ain't right" vibe. I don't like those pulse and resp rates. Better get that monitor on her quick.
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Post by valleytech36 on Mar 14, 2005 6:59:33 GMT -5
I would have to say the patient is probably an Anorexia nervosa.
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9Wacker1
Full Member
Wacker - and proud of it!
Posts: 54
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Post by 9Wacker1 on Mar 14, 2005 9:42:30 GMT -5
My initial question is why is the blood glucose level so high (210) when she hasn't eaten in three days? Is there some other liquid being consumed? If so that could explain some symptoms.
There is also the underlying problem of the increased migraines which could possibly point to a brain tumor or something.
I would not feel comfortable letting this patient sign off and drive herself home. I think I would very thoroughly check her alertness and orientation and if their was reasonable doubt to her ability to make an informed decision, I would follow protocols and transport.
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Post by Medic13 on Mar 14, 2005 10:29:43 GMT -5
Definitely can't rule it out, Wacker1, but I think a tumor is a little extreme at this point. Those vitals just don't match up. The resp rate shouldn't be 32 with a pulse of 60. I'm actually starting to think that a combination of my first list is the culprit. I'm thinking the glucose level (which is high, but not extremely high) is due to an electrolyte shift, which was ultimitely caused by a seizure. If that's the case, the unusual resp rate could be explained as a metabolic compensation. She definitely needs a trip to the ER.
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Post by blueeighty8 on Mar 14, 2005 10:53:07 GMT -5
Now I don't know about this, again, just pasting. But I did include the ecg. Wolf-Parkinson-White Syndrome The short PR interval is due to the presence of a bypass track. By bypassing the AV node the PR shortens. The delta wave represents early activation of the ventricles from the bypass tract. The fusion QRS is the result of two activation sequences, one from the bypass tract and one from the AV node. The ST-T changes are secondary to changes in the ventricular activation sequence. Patients may present complaining of dyspnea, palpitations, chest pain or altered mental status secondary to decreased cerebral perfusion.
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Post by Medic13 on Mar 14, 2005 11:39:59 GMT -5
Hmmm ...didn't see that coming.
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