Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Two things immediately come to mind... CVA or substance abuse / drug reaction...could be hypoglycemia, but need more information - I would continue the assessment, need more information... Les NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF Senior Safety Coordinator / Emergency Response Coordinator Westlake Chemical P.O. Box 228 36045 LA 30 Geismar, LA 70734-0228 e-Mail: lpowell@... Telephone: Fax: Cell: 225.439-6552 Captain / Training Officer - 7th District Fire Department - http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... %20FD707@...> Captain / Training Officer - Geismar Fire Department - http://www.apfire.us/ http://www.apfire.us/> Industrial Fire World Advisory Board - Industrial Fire World http://www.fireworld.com/> Secretary - Geismar Area Mutual Aid Association (GAMA) - http:www.gamaid.org Affiliate Advisory Council - Texas: National Association of Emergency Medical Technicians http://www.naemt.org/> Board of Directors - Emergency Medical Services Association of Texas (EMSAT) http://www.texasemsat.org/> " Next to creating a life, the finest thing a man can do is save one. " - Abraham Lincoln ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Thursday, June 10, 2010 18:15 To: Paramedicine ; texasems-l Subject: EMS challenge Since it's been a while since Professor Gandy offered a challenge (and the prize-winner's trip to Ladonia), I present the following brain-teaser for all of y'all. Alas, there are no prizes since the half-star hotel resort in Ladonia is closed for fumigation. On to the challenge...... you are dispatched to an altered mental status call. Upon arrival, you find a middle-aged female laying on the floor of an office. She is semi-coherent and semi-combative, with slurred speech. Her co-workers know that she has an extensive medical history, but they can't remember what it is. Oddly, while the patient is breathing and speaking (although abnormally), you cannot obtain a radial pulse or a blood pressure. You do find a palpable carotid pulse at 72 bpm. What is happening to the patient and what is the underlying etiology? -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. -Attorney at Law/Licensed Paramedic -Austin, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Two things immediately come to mind... CVA or substance abuse / drug reaction...could be hypoglycemia, but need more information - I would continue the assessment, need more information... Les NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF Senior Safety Coordinator / Emergency Response Coordinator Westlake Chemical P.O. Box 228 36045 LA 30 Geismar, LA 70734-0228 e-Mail: lpowell@... Telephone: Fax: Cell: 225.439-6552 Captain / Training Officer - 7th District Fire Department - http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... %20FD707@...> Captain / Training Officer - Geismar Fire Department - http://www.apfire.us/ http://www.apfire.us/> Industrial Fire World Advisory Board - Industrial Fire World http://www.fireworld.com/> Secretary - Geismar Area Mutual Aid Association (GAMA) - http:www.gamaid.org Affiliate Advisory Council - Texas: National Association of Emergency Medical Technicians http://www.naemt.org/> Board of Directors - Emergency Medical Services Association of Texas (EMSAT) http://www.texasemsat.org/> " Next to creating a life, the finest thing a man can do is save one. " - Abraham Lincoln ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Thursday, June 10, 2010 18:15 To: Paramedicine ; texasems-l Subject: EMS challenge Since it's been a while since Professor Gandy offered a challenge (and the prize-winner's trip to Ladonia), I present the following brain-teaser for all of y'all. Alas, there are no prizes since the half-star hotel resort in Ladonia is closed for fumigation. On to the challenge...... you are dispatched to an altered mental status call. Upon arrival, you find a middle-aged female laying on the floor of an office. She is semi-coherent and semi-combative, with slurred speech. Her co-workers know that she has an extensive medical history, but they can't remember what it is. Oddly, while the patient is breathing and speaking (although abnormally), you cannot obtain a radial pulse or a blood pressure. You do find a palpable carotid pulse at 72 bpm. What is happening to the patient and what is the underlying etiology? -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. -Attorney at Law/Licensed Paramedic -Austin, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Two things immediately come to mind... CVA or substance abuse / drug reaction...could be hypoglycemia, but need more information - I would continue the assessment, need more information... Les NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF Senior Safety Coordinator / Emergency Response Coordinator Westlake Chemical P.O. Box 228 36045 LA 30 Geismar, LA 70734-0228 e-Mail: lpowell@... Telephone: Fax: Cell: 225.439-6552 Captain / Training Officer - 7th District Fire Department - http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... %20FD707@...> Captain / Training Officer - Geismar Fire Department - http://www.apfire.us/ http://www.apfire.us/> Industrial Fire World Advisory Board - Industrial Fire World http://www.fireworld.com/> Secretary - Geismar Area Mutual Aid Association (GAMA) - http:www.gamaid.org Affiliate Advisory Council - Texas: National Association of Emergency Medical Technicians http://www.naemt.org/> Board of Directors - Emergency Medical Services Association of Texas (EMSAT) http://www.texasemsat.org/> " Next to creating a life, the finest thing a man can do is save one. " - Abraham Lincoln ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Thursday, June 10, 2010 18:15 To: Paramedicine ; texasems-l Subject: EMS challenge Since it's been a while since Professor Gandy offered a challenge (and the prize-winner's trip to Ladonia), I present the following brain-teaser for all of y'all. Alas, there are no prizes since the half-star hotel resort in Ladonia is closed for fumigation. On to the challenge...... you are dispatched to an altered mental status call. Upon arrival, you find a middle-aged female laying on the floor of an office. She is semi-coherent and semi-combative, with slurred speech. Her co-workers know that she has an extensive medical history, but they can't remember what it is. Oddly, while the patient is breathing and speaking (although abnormally), you cannot obtain a radial pulse or a blood pressure. You do find a palpable carotid pulse at 72 bpm. What is happening to the patient and what is the underlying etiology? -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. -Attorney at Law/Licensed Paramedic -Austin, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 CVS is a very real possibility and is actually the current emergency. What about her underlying condition is the reason for the CVA? Wes Ogilvie Sent from my iPhone > Two things immediately come to mind... CVA or substance abuse / drug > reaction...could be hypoglycemia, but need more information - I would > continue the assessment, need more information... > > > Les > > NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF > > Senior Safety Coordinator / Emergency Response Coordinator > > Westlake Chemical > > P.O. Box 228 > > 36045 LA 30 > > Geismar, LA 70734-0228 > > e-Mail: lpowell@... > > Telephone: > > Fax: > > Cell: 225.439-6552 > > Captain / Training Officer - 7th District Fire Department - > http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... > %20FD707@...> > > Captain / Training Officer - Geismar Fire Department - > http://www.apfire.us/ http://www.apfire.us/> > > Industrial Fire World Advisory Board - Industrial Fire World > http://www.fireworld.com/> > > Secretary - Geismar Area Mutual Aid Association (GAMA) - > http:www.gamaid.org > > Affiliate Advisory Council - Texas: National Association of Emergency > Medical Technicians http://www.naemt.org/> > > Board of Directors - Emergency Medical Services Association of Texas > (EMSAT) http://www.texasemsat.org/> > > " Next to creating a life, the finest thing a man can do is save > one. " - > Abraham Lincoln > > ________________________________ > > From: texasems-l [mailto:texasems-l ] > On > Behalf Of ExLngHrn@... > Sent: Thursday, June 10, 2010 18:15 > To: Paramedicine ; texasems-l > Subject: EMS challenge > > Since it's been a while since Professor Gandy offered a challenge (and > the > prize-winner's trip to Ladonia), I present the following brain-teaser > for > all of y'all. Alas, there are no prizes since the half-star hotel > resort > > in Ladonia is closed for fumigation. > > On to the challenge...... you are dispatched to an altered mental > status > > call. Upon arrival, you find a middle-aged female laying on the > floor of > an > office. She is semi-coherent and semi-combative, with slurred speech. > Her > co-workers know that she has an extensive medical history, but they > can't > remember what it is. > > Oddly, while the patient is breathing and speaking (although > abnormally), > you cannot obtain a radial pulse or a blood pressure. You do find a > palpable carotid pulse at 72 bpm. > > What is happening to the patient and what is the underlying etiology? > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > -Attorney at Law/Licensed Paramedic > -Austin, Texas > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 CVS is a very real possibility and is actually the current emergency. What about her underlying condition is the reason for the CVA? Wes Ogilvie Sent from my iPhone > Two things immediately come to mind... CVA or substance abuse / drug > reaction...could be hypoglycemia, but need more information - I would > continue the assessment, need more information... > > > Les > > NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF > > Senior Safety Coordinator / Emergency Response Coordinator > > Westlake Chemical > > P.O. Box 228 > > 36045 LA 30 > > Geismar, LA 70734-0228 > > e-Mail: lpowell@... > > Telephone: > > Fax: > > Cell: 225.439-6552 > > Captain / Training Officer - 7th District Fire Department - > http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... > %20FD707@...> > > Captain / Training Officer - Geismar Fire Department - > http://www.apfire.us/ http://www.apfire.us/> > > Industrial Fire World Advisory Board - Industrial Fire World > http://www.fireworld.com/> > > Secretary - Geismar Area Mutual Aid Association (GAMA) - > http:www.gamaid.org > > Affiliate Advisory Council - Texas: National Association of Emergency > Medical Technicians http://www.naemt.org/> > > Board of Directors - Emergency Medical Services Association of Texas > (EMSAT) http://www.texasemsat.org/> > > " Next to creating a life, the finest thing a man can do is save > one. " - > Abraham Lincoln > > ________________________________ > > From: texasems-l [mailto:texasems-l ] > On > Behalf Of ExLngHrn@... > Sent: Thursday, June 10, 2010 18:15 > To: Paramedicine ; texasems-l > Subject: EMS challenge > > Since it's been a while since Professor Gandy offered a challenge (and > the > prize-winner's trip to Ladonia), I present the following brain-teaser > for > all of y'all. Alas, there are no prizes since the half-star hotel > resort > > in Ladonia is closed for fumigation. > > On to the challenge...... you are dispatched to an altered mental > status > > call. Upon arrival, you find a middle-aged female laying on the > floor of > an > office. She is semi-coherent and semi-combative, with slurred speech. > Her > co-workers know that she has an extensive medical history, but they > can't > remember what it is. > > Oddly, while the patient is breathing and speaking (although > abnormally), > you cannot obtain a radial pulse or a blood pressure. You do find a > palpable carotid pulse at 72 bpm. > > What is happening to the patient and what is the underlying etiology? > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > -Attorney at Law/Licensed Paramedic > -Austin, Texas > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 CVS is a very real possibility and is actually the current emergency. What about her underlying condition is the reason for the CVA? Wes Ogilvie Sent from my iPhone > Two things immediately come to mind... CVA or substance abuse / drug > reaction...could be hypoglycemia, but need more information - I would > continue the assessment, need more information... > > > Les > > NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF > > Senior Safety Coordinator / Emergency Response Coordinator > > Westlake Chemical > > P.O. Box 228 > > 36045 LA 30 > > Geismar, LA 70734-0228 > > e-Mail: lpowell@... > > Telephone: > > Fax: > > Cell: 225.439-6552 > > Captain / Training Officer - 7th District Fire Department - > http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@... > %20FD707@...> > > Captain / Training Officer - Geismar Fire Department - > http://www.apfire.us/ http://www.apfire.us/> > > Industrial Fire World Advisory Board - Industrial Fire World > http://www.fireworld.com/> > > Secretary - Geismar Area Mutual Aid Association (GAMA) - > http:www.gamaid.org > > Affiliate Advisory Council - Texas: National Association of Emergency > Medical Technicians http://www.naemt.org/> > > Board of Directors - Emergency Medical Services Association of Texas > (EMSAT) http://www.texasemsat.org/> > > " Next to creating a life, the finest thing a man can do is save > one. " - > Abraham Lincoln > > ________________________________ > > From: texasems-l [mailto:texasems-l ] > On > Behalf Of ExLngHrn@... > Sent: Thursday, June 10, 2010 18:15 > To: Paramedicine ; texasems-l > Subject: EMS challenge > > Since it's been a while since Professor Gandy offered a challenge (and > the > prize-winner's trip to Ladonia), I present the following brain-teaser > for > all of y'all. Alas, there are no prizes since the half-star hotel > resort > > in Ladonia is closed for fumigation. > > On to the challenge...... you are dispatched to an altered mental > status > > call. Upon arrival, you find a middle-aged female laying on the > floor of > an > office. She is semi-coherent and semi-combative, with slurred speech. > Her > co-workers know that she has an extensive medical history, but they > can't > remember what it is. > > Oddly, while the patient is breathing and speaking (although > abnormally), > you cannot obtain a radial pulse or a blood pressure. You do find a > palpable carotid pulse at 72 bpm. > > What is happening to the patient and what is the underlying etiology? > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > -Attorney at Law/Licensed Paramedic > -Austin, Texas > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 How are the eyes? And evidence of jaundice? Skin color? How about the abdomen? Distension or swollen organs? Granberry > > > > > Since Enbrel can cause demyelinating cns disorders I am going to > > > guess neuro issues from the Enbrel > > > Rick > > > Sent via Blackberry > > > > > > ________________________________ > > > From: texasems-l texasems-l > > > > To: texasems-l texasems-l > > > > Sent: Thu Jun 10 18:35:40 2010 > > > Subject: Re: EMS challenge > > > > > > > > > > > > Your scene is a fairly normal office building. Blood sugar is 128 mg/ > > > dL. > > > Pupils unequal. Obvious weakness left side when you check a stroke > > > scale. > > > No medical alert tag. No obvious signs of trauma. The only medicine > > > you find on scene is a box containing a drug called Enbrel. > > > > > > -Wes > > > > > > > > > In a message dated 6/10/2010 6:29:32 P.M. Central Daylight Time, > > > lrichardson@... > > %40ci.duncanville.tx.us> writes: > > > > > > Ok Professor Wes! > > > > > > Some clues please! scene findings? other VS's? Blood Sugar? Stroke > > > Scale? Pupils? Obvious trauma? medical alert tags? meds on scene? > > > ________________________________ > > > From: texasems-l > > %40yahoogroups.com> [texasems-l > > %40yahoogroups.com>] On Behalf Of > > > ExLngHrn@... > > > [ExLngHrn@... ] > > > Sent: Thursday, June 10, 2010 6:14 PM > > > To: Paramedicine > > %40yahoogroups.com>; texasems-l > > %40yahoogroups.com> > > > Subject: EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 No jaundice. Pupils unequal. Skin is pink, warm, dry. Abdomen is not abnormal. -Wes In a message dated 6/11/2010 4:27:19 P.M. Central Daylight Time, holcaul@... writes: How are the eyes? And evidence of jaundice? Skin color? How about the abdomen? Distension or swollen organs? Granberry > > > > > Since Enbrel can cause demyelinating cns disorders I am going to > > > guess neuro issues from the Enbrel > > > Rick > > > Sent via Blackberry > > > > > > ________________________________ > > > From: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > > > > To: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > > > > Sent: Thu Jun 10 18:35:40 2010 > > > Subject: Re: EMS challenge > > > > > > > > > > > > Your scene is a fairly normal office building. Blood sugar is 128 mg/ > > > dL. > > > Pupils unequal. Obvious weakness left side when you check a stroke > > > scale. > > > No medical alert tag. No obvious signs of trauma. The only medicine > > > you find on scene is a box containing a drug called Enbrel. > > > > > > -Wes > > > > > > > > > In a message dated 6/10/2010 6:29:32 P.M. Central Daylight Time, > > > lrichardson@... > > %40ci.duncanville.tx.us> writes: > > > > > > Ok Professor Wes! > > > > > > Some clues please! scene findings? other VS's? Blood Sugar? Stroke > > > Scale? Pupils? Obvious trauma? medical alert tags? meds on scene? > > > ________________________________ > > > From: _texasems-l _ (mailto:texasems-l ) > > %40yahoogroups.com> [_texasems-l _ (mailto:texasems-l ) > > %40yahoogroups.com>] On Behalf Of > > > ExLngHrn@... > > > [ExLngHrn@... ] > > > Sent: Thursday, June 10, 2010 6:14 PM > > > To: _Paramedicine _ (mailto:Paramedicine ) > > %40yahoogroups.com>; _texasems-l _ (mailto:texasems-l ) > > %40yahoogroups.com> > > > Subject: EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Brachial is not palpable. Carotid and femoral are both strong and regular. -Wes In a message dated 6/11/2010 4:28:24 P.M. Central Daylight Time, bradsattler@... writes: Wes, Is there a weakly palpable bracheal and a more pronounced femoral pulse? Also, would you describe the carotid as a bounding pulse? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > Since it's been a while since Professor Gandy offered a challenge (and > the > prize-winner's trip to Ladonia), I present the following brain-teaser > for > all of y'all. Alas, there are no prizes since the half-star hotel > resort > > in Ladonia is closed for fumigation. > > On to the challenge...... you are dispatched to an altered mental > status > > call. Upon arrival, you find a middle-aged female laying on the > floor of > an > office. She is semi-coherent and semi-combative, with slurred speech. > Her > co-workers know that she has an extensive medical history, but they > can't > remember what it is. > > Oddly, while the patient is breathing and speaking (although > abnormally), > you cannot obtain a radial pulse or a blood pressure. You do find a > palpable carotid pulse at 72 bpm. > > What is happening to the patient and what is the underlying etiology? > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > -Attorney at Law/Licensed Paramedic > -Austin, Texas > > [Non-text portions of this message have been removed] > > ***** Named to Fortune's 1000 list for 2009**** > > ***** Ranked in Industry Week's " 1000 Largest Manufacturing > Companies in the World " 2009 list. ***** > > * Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Wes, Is there a weakly palpable bracheal and a more pronounced femoral pulse? Also, would you describe the carotid as a bounding pulse? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > Since it's been a while since Professor Gandy offered a challenge (and > the > prize-winner's trip to Ladonia), I present the following brain-teaser > for > all of y'all. Alas, there are no prizes since the half-star hotel > resort > > in Ladonia is closed for fumigation. > > On to the challenge...... you are dispatched to an altered mental > status > > call. Upon arrival, you find a middle-aged female laying on the > floor of > an > office. She is semi-coherent and semi-combative, with slurred speech. > Her > co-workers know that she has an extensive medical history, but they > can't > remember what it is. > > Oddly, while the patient is breathing and speaking (although > abnormally), > you cannot obtain a radial pulse or a blood pressure. You do find a > palpable carotid pulse at 72 bpm. > > What is happening to the patient and what is the underlying etiology? > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > -Attorney at Law/Licensed Paramedic > -Austin, Texas > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, drdugud@... writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler bradsattler@...>wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Close.... but no cigar. -Wes In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time, rick.moore@... writes: Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > To: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, _drdugud@..._ (mailto:drdugud@...) writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler _bradsattler@..._ (mailto:bradsattler@...) >wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 does she have tender temples? ck In a message dated 6/11/2010 20:55:02 Central Daylight Time, ExLngHrn@... writes: Close.... but no cigar. -Wes In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time, _rick.moore@..._ (mailto:rick.moore@...) writes: Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > To: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, __drdugud@..._ (mailto:_drdugud@...) _ (mailto:_drdugud@..._ (mailto:drdugud@...) ) writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler __bradsattler@..._ (mailto:_bradsattler@...) _ (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) >wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 no. -Wes In a message dated 6/11/2010 8:57:07 P.M. Central Daylight Time, krin135@... writes: does she have tender temples? ck In a message dated 6/11/2010 20:55:02 Central Daylight Time, _ExLngHrn@..._ (mailto:ExLngHrn@...) writes: Close.... but no cigar. -Wes In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time, __rick.moore@..._ (mailto:_rick.moore@...) _ (mailto:_rick.moore@..._ (mailto:rick.moore@...) ) writes: Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: ___texasems-l _ (mailto:__texasems-l ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) ) ___texasems-l _ (mailto:__texasems-l ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) ) > To: ___texasems-l _ (mailto:__texasems-l ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) ) ___texasems-l _ (mailto:__texasems-l ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) ) _ (mailto:__texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) ) > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, ___drdugud@..._ (mailto:__drdugud@...) _ (mailto:__drdugud@..._ (mailto:_drdugud@...) ) _ (mailto:__drdugud@..._ (mailto:_drdugud@...) _ (mailto:_drdugud@..._ (mailto:drdugud@...) ) ) writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler ___bradsattler@..._ (mailto:__bradsattler@...) _ (mailto:__bradsattler@..._ (mailto:_bradsattler@...) ) _ (mailto:__bradsattler@..._ (mailto:_bradsattler@...) _ (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) ) >wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 how are her pupillary responses? ck In a message dated 6/11/2010 20:55:02 Central Daylight Time, ExLngHrn@... writes: Close.... but no cigar. -Wes In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time, _rick.moore@..._ (mailto:rick.moore@...) writes: Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > To: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, __drdugud@..._ (mailto:_drdugud@...) _ (mailto:_drdugud@..._ (mailto:drdugud@...) ) writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler __bradsattler@..._ (mailto:_bradsattler@...) _ (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) >wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Ascites? Fistula? Dialysis patient? Kelley Sent on the Sprint® Now Network from my BlackBerry® EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Senor Cardenas: What game? a good paramedic is offering a case scenario (and doing a decent job of it), practicing his teaching skills while trying to get other folks to think outside the paramedic cook book. This is the sort of thing that we need more of on the various paramedic groups. I can assure you that there are similar cases being presented on the 'real' medical groups all the time, albeit frequently being posed in search of other treatment options for really screwy (read zebra or even unicorn) cases. ck In a message dated 6/11/2010 21:55:09 Central Daylight Time, luis.cardenas@... writes: Can you play this game somewhere else. ________________________________ From: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > To: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > Sent: Fri Jun 11 21:41:09 2010 Subject: Re: EMS challenge Yeah, I was working toward lymphoma Wes, but we're trying to differential diagnose here. Her possible demyialation (sp?) might be causing stroke-like symptoms, but it's also possible that engorged lymph nodes are blocking peripheral circulation and causing increased vascular pressure system-wide, leading to a brain bleed. .. Is that getting close? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 As a BASIC I learn a fair amount from these types of discussions and when I am lost I use DELETE. Seems to work well. Once again EMS eats their young while bitching out of the other side of the mouth about how we get no respect. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 6/11/2010 10:26:25 P.M. Central Daylight Time, staffdoc9109@... writes: Mr Cardenas, You must be kidding. As one of the moderators of this list I commend Wes for starting such a productive discussion. I think Dr Krin said it best that this is a teaching discussion. If you don't like the thread then hit delete. Bernie Stafford EMTP -----Original Message----- From: _texasems-l _ (mailto:texasems-l ) [mailto:_texasems-l _ (mailto:texasems-l ) ] On Behalf Of Cardenas, Sent: Friday, June 11, 2010 10:17 PM To: _texasems-l _ (mailto:texasems-l ) Subject: Re: EMS challenge Then answer the ? And stop clogging up the site. ________________________________ From: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > To: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > Sent: Fri Jun 11 21:59:05 2010 Subject: Re: EMS challenge Senor Cardenas: What game? a good paramedic is offering a case scenario (and doing a decent job of it), practicing his teaching skills while trying to get other folks to think outside the paramedic cook book. This is the sort of thing that we need more of on the various paramedic groups. I can assure you that there are similar cases being presented on the 'real' medical groups all the time, albeit frequently being posed in search of other treatment options for really screwy (read zebra or even unicorn) cases. ck In a message dated 6/11/2010 21:55:09 Central Daylight Time, _luis.cardenas@..._ (mailto:luis.cardenas@...) writes: Can you play this game somewhere else. ________________________________ From: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > To: __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) __texasems-l _ (mailto:_texasems-l ) _ (mailto:_texasems-l _ (mailto:texasems-l ) ) > Sent: Fri Jun 11 21:41:09 2010 Subject: Re: EMS challenge Yeah, I was working toward lymphoma Wes, but we're trying to differential diagnose here. Her possible demyialation (sp?) might be causing stroke-like symptoms, but it's also possible that engorged lymph nodes are blocking peripheral circulation and causing increased vascular pressure system-wide, leading to a brain bleed. .. Is that getting close? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler bradsattler@...>wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: texasems-l texasems-l > To: texasems-l texasems-l > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, drdugud@... writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler bradsattler@...>wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 DVT that breaks off and travels to the brain? From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Friday, June 11, 2010 8:55 PM To: texasems-l Subject: Re: EMS challenge Close.... but no cigar. -Wes In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time, rick.moore@... writes: Cva due to atherosclerosis secondary to rheumotoid arthritis Rick Sent via Blackberry ________________________________ From: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > To: _texasems-l _ (mailto:texasems-l ) _texasems-l _ (mailto:texasems-l ) > Sent: Fri Jun 11 20:34:11 2010 Subject: Re: EMS challenge Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it more likely that the CVA is caused by a condition she's taking Enbrel for? (BIG HINT THERE) -Wes In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time, _drdugud@... _ (mailto:drdugud@... ) writes: CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to cause demyelinating CNS disorders. Close? Neil On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler _bradsattler@... _ (mailto:bradsattler@... ) >wrote: > > > Wes, > > Would you describe this patient as " thin " by any chance? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 what is the ethnic background of the patient? ck In a message dated 6/11/2010 22:42:45 Central Daylight Time, ExLngHrn@... writes: Alas, no. Wes Sent from my iPhone On Jun 11, 2010, at 21:41, " Brad Sattler " _bradsattler@..._ (mailto:bradsattler@...) > wrote: > Yeah, I was working toward lymphoma Wes, but we're trying to > differential diagnose here. > > Her possible demyialation (sp?) might be causing stroke-like > symptoms, but it's also possible that engorged lymph nodes are > blocking peripheral circulation and causing increased vascular > pressure system-wide, leading to a brain bleed. > . > Is that getting close? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but > they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do > find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying > etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > [Non-text portions of this message have been removed] > > > > > > ------------------------------------ > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Can you play this game somewhere else. ________________________________ From: texasems-l texasems-l > To: texasems-l texasems-l > Sent: Fri Jun 11 21:41:09 2010 Subject: Re: EMS challenge Yeah, I was working toward lymphoma Wes, but we're trying to differential diagnose here. Her possible demyialation (sp?) might be causing stroke-like symptoms, but it's also possible that engorged lymph nodes are blocking peripheral circulation and causing increased vascular pressure system-wide, leading to a brain bleed. .. Is that getting close? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Yeah, I was working toward lymphoma Wes, but we're trying to differential diagnose here. Her possible demyialation (sp?) might be causing stroke-like symptoms, but it's also possible that engorged lymph nodes are blocking peripheral circulation and causing increased vascular pressure system-wide, leading to a brain bleed. .. Is that getting close? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > [Non-text portions of this message have been removed] > > > > ------------------------------------ > > > > Yahoo! Groups Links > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 make that *much* more common in relatively young Asian females. this is a real zebra, almost a unicorn. I recall seeing *one* patient with this disease in 35 years of practice. ck In a message dated 6/12/2010 01:43:07 Central Daylight Time, ExLngHrn@... writes: Caucasian. However her underlying medical history is more common in Asian females. Wes Sent from my iPhone On Jun 12, 2010, at 1:33, _krin135@..._ (mailto:krin135@...) wrote: > what is the ethnic background of the patient? > > ck > > > In a message dated 6/11/2010 22:42:45 Central Daylight Time, > _ExLngHrn@..._ (mailto:ExLngHrn@...) writes: > > Alas, no. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 21:41, " Brad Sattler " __bradsattler@..._ (mailto:_bradsattler@...) _ > (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) > wrote: > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but it's also possible that engorged lymph nodes are > > blocking peripheral circulation and causing increased vascular > > pressure system-wide, leading to a brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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