Guest guest Posted December 12, 2008 Report Share Posted December 12, 2008 It's been a while since we had a puzzler, so I present this one for your consideration. Medic 843 is called to a private residence where they find a 31 year old male who was in a motor vehicle collision 6 months earlier and sustained a spinal injury at T5 that rendered him a quadriplegic. He is in supine in bed, complaining of a splitting headache, and his wife tells you that this started about a half an hour before. He is in quite a bit of distress from the pain of the headache, holding his head and moaning, and his wife has put a towel with some ice in it on his forehead. You note that his face and chest are flushed and sweating and he appears to also have goose bumps. He is breathing rapidly. His pulse is 42, and his BP is 258/146. Upon removing his clothing you see that he has a Foley bag full of pale yellow and clear urine, and that his lower extremities are pale and cool, whereas his upper extremities are pink and warm. His pupils are 8 mm What is his likely condition, its probable cause, and what measures can a basic EMT take to treat his condition immediately? What interventions could a paramedic do? If you were on the other list I presented this to, please refrain from answering until the people on these lists get a chance. Gene G. ************** Make your life easier with all your friends, email, and favorite sites in one place. Try it now. (http://www.aol.com/?optin=new-dp & amp; icid=aolcom40vanity & amp;ncid=emlcntaolcom00000010) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2008 Report Share Posted December 12, 2008 WOW, Ben! Absolutely correct! Congratulations. That's a hard one. Gene > > Good case. Given the time since the spinal cord injury, the location of > the injury, the severe hypertension w/ bradycardia, and localized > diaphoresis, goosebumps and vasoconstriction below the injury -- it's > clearly related to the spinal cord injury. My clinical impression is > autonomic dysreflexia. auto > > At the BLS level, if this guy is supine, I'd consider sitting him up, > perhaps getting his legs over the side of the bed to temporarily help > with the HTN. I suspect the stimuli causing the AD is the full > collection bag -- so immediately emptying that should hopefully relieve > these symptoms. > > I'd keep ALS coming, in case that wasn't the triggering stimuli, in case > pharmacological treatment of symptoms (namely HTN) is necessary, because > if he stays that hypertensive, bad news is coming...... if h > > Ben Oakley, EMTB > > wegandy1938@wegandy wrote: > > > > It's been a while since we had a puzzler, so I present this one for your > > consideration. > > > > Medic 843 is called to a private residence where they find a 31 year > > old male > > who was in a motor vehicle collision 6 months earlier and sustained a > > spinal > > injury at T5 that rendered him a quadriplegic. > > > > He is in supine in bed, complaining of a splitting headache, and his wife > > tells you that this started about a half an hour before. > > > > He is in quite a bit of distress from the pain of the headache, > > holding his > > head and moaning, and his wife has put a towel with some ice in it on his > > forehead. > > > > You note that his face and chest are flushed and sweating and he > > appears to > > also have goose bumps. He is breathing rapidly. His pulse is 42, and > > his BP > > is 258/146. Upon removing his clothing you see that he has a Foley bag > > full > > of pale yellow and clear urine, and that his lower extremities are > > pale and > > cool, whereas his upper extremities are pink and warm. His pupils are 8 mm > > > > What is his likely condition, its probable cause, and what measures can a > > basic EMT take to treat his condition immediately? What interventions > > could a > > paramedic do? > > > > If you were on the other list I presented this to, please refrain from > > answering until the people on these lists get a chance. > > > > Gene G. > > > > ************ * > > Make your life easier with all your friends, email, and > > favorite sites in one place. Try it now. > > (http://www.aol.http://www.http:/ & amp; > > <http://www.aol.http://www.http:/ & amp;> > > icid=aolcom40vanity & amp;ncid=amp;ncid=<wbr>emamp;n > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2008 Report Share Posted December 12, 2008 Good case. Given the time since the spinal cord injury, the location of the injury, the severe hypertension w/ bradycardia, and localized diaphoresis, goosebumps and vasoconstriction below the injury -- it's clearly related to the spinal cord injury. My clinical impression is autonomic dysreflexia...... At the BLS level, if this guy is supine, I'd consider sitting him up, perhaps getting his legs over the side of the bed to temporarily help with the HTN. I suspect the stimuli causing the AD is the full collection bag -- so immediately emptying that should hopefully relieve these symptoms. I'd keep ALS coming, in case that wasn't the triggering stimuli, in case pharmacological treatment of symptoms (namely HTN) is necessary, because if he stays that hypertensive, bad news is coming........... Ben Oakley, EMTB wegandy1938@... wrote: > > It's been a while since we had a puzzler, so I present this one for your > consideration. > > Medic 843 is called to a private residence where they find a 31 year > old male > who was in a motor vehicle collision 6 months earlier and sustained a > spinal > injury at T5 that rendered him a quadriplegic. > > He is in supine in bed, complaining of a splitting headache, and his wife > tells you that this started about a half an hour before. > > He is in quite a bit of distress from the pain of the headache, > holding his > head and moaning, and his wife has put a towel with some ice in it on his > forehead. > > You note that his face and chest are flushed and sweating and he > appears to > also have goose bumps. He is breathing rapidly. His pulse is 42, and > his BP > is 258/146. Upon removing his clothing you see that he has a Foley bag > full > of pale yellow and clear urine, and that his lower extremities are > pale and > cool, whereas his upper extremities are pink and warm. His pupils are 8 mm > > What is his likely condition, its probable cause, and what measures can a > basic EMT take to treat his condition immediately? What interventions > could a > paramedic do? > > If you were on the other list I presented this to, please refrain from > answering until the people on these lists get a chance. > > Gene G. > > ************** > Make your life easier with all your friends, email, and > favorite sites in one place. Try it now. > (http://www.aol.com/?optin=new-dp & amp; > <http://www.aol.com/?optin=new-dp & amp;> > icid=aolcom40vanity & amp;ncid=emlcntaolcom00000010) > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 13, 2008 Report Share Posted December 13, 2008 Counselor, I'd submit that it's obviously not THAT hard for Mr. Oakley. lol... Phil Reynolds Jr. 115 Harold Dr. Burnet, TX., 78611 HP CP Re: Time for a puzzler WOW, Ben! Absolutely correct! Congratulations. That's a hard one. Gene > > Good case. Given the time since the spinal cord injury, the location of > the injury, the severe hypertension w/ bradycardia, and localized > diaphoresis, goosebumps and vasoconstriction below the injury -- it's > clearly related to the spinal cord injury. My clinical impression is > autonomic dysreflexia. auto > > At the BLS level, if this guy is supine, I'd consider sitting him up, > perhaps getting his legs over the side of the bed to temporarily help > with the HTN. I suspect the stimuli causing the AD is the full > collection bag -- so immediately emptying that should hopefully relieve > these symptoms. > > I'd keep ALS coming, in case that wasn't the triggering stimuli, in case > pharmacological treatment of symptoms (namely HTN) is necessary, because > if he stays that hypertensive, bad news is coming...... if h > > Ben Oakley, EMTB > > wegandy1938@wegandy wrote: > > > > It's been a while since we had a puzzler, so I present this one for your > > consideration. > > > > Medic 843 is called to a private residence where they find a 31 year > > old male > > who was in a motor vehicle collision 6 months earlier and sustained a > > spinal > > injury at T5 that rendered him a quadriplegic. > > > > He is in supine in bed, complaining of a splitting headache, and his wife > > tells you that this started about a half an hour before. > > > > He is in quite a bit of distress from the pain of the headache, > > holding his > > head and moaning, and his wife has put a towel with some ice in it on his > > forehead. > > > > You note that his face and chest are flushed and sweating and he > > appears to > > also have goose bumps. He is breathing rapidly. His pulse is 42, and > > his BP > > is 258/146. Upon removing his clothing you see that he has a Foley bag > > full > > of pale yellow and clear urine, and that his lower extremities are > > pale and > > cool, whereas his upper extremities are pink and warm. His pupils are 8 mm > > > > What is his likely condition, its probable cause, and what measures can a > > basic EMT take to treat his condition immediately? What interventions > > could a > > paramedic do? > > > > If you were on the other list I presented this to, please refrain from > > answering until the people on these lists get a chance. > > > > Gene G. > > > > ************ * > > Make your life easier with all your friends, email, and > > favorite sites in one place. Try it now. > > (http://www.aol.http://www.http:/ & > > <http://www.aol.http://www.http:/ & > > > icid=aolcom40vanity & amp;ncid=amp;ncid=<wbr>emamp;n > > > > Quote Link to comment Share on other sites More sharing options...
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