Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Is there any insect bite marks? Sent from my iPhone > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > She seems entirely sure that she's fine, on the other hand. > > I like the direction you're going. Never forget the basics. > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > Lots of symptoms, few signs... > > > > Alyssa Woods, NREMT-B > CPR Instructor > > > > > >> Ok, I'll bite, on a strictly EMT-B level >> >> First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. >> >> Notify the parents to keep an eye on her, and call back if things get worse, >> >> If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. >> >> MAKE SURE to get the refusal signed by her before leaving. >> >> Chances are, you'll be back. >> >> The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. >> >> Otherwise, you cant even take a B/P without her permission. >> >> Coug. >> >> I'll keep my Guns, my Freedom and my MONEY, >> You can keep the " CHANGE. " >> >> >> >> >> Subject: EMS Challenge >> To: texasems-l >> Date: Thursday, January 6, 2011, 1:16 PM >> >> >> >> I think we're about due for another challenge, if anyone is up for it. >> >> You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. >> >> The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. >> >> Alyssa Woods, NREMT-B >> >> CPR Instructor >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Is there any insect bite marks? Sent from my iPhone > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > She seems entirely sure that she's fine, on the other hand. > > I like the direction you're going. Never forget the basics. > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > Lots of symptoms, few signs... > > > > Alyssa Woods, NREMT-B > CPR Instructor > > > > > >> Ok, I'll bite, on a strictly EMT-B level >> >> First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. >> >> Notify the parents to keep an eye on her, and call back if things get worse, >> >> If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. >> >> MAKE SURE to get the refusal signed by her before leaving. >> >> Chances are, you'll be back. >> >> The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. >> >> Otherwise, you cant even take a B/P without her permission. >> >> Coug. >> >> I'll keep my Guns, my Freedom and my MONEY, >> You can keep the " CHANGE. " >> >> >> >> >> Subject: EMS Challenge >> To: texasems-l >> Date: Thursday, January 6, 2011, 1:16 PM >> >> >> >> I think we're about due for another challenge, if anyone is up for it. >> >> You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. >> >> The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. >> >> Alyssa Woods, NREMT-B >> >> CPR Instructor >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Assuming she will allow us, we should now do an evaluation of her cranial nerves. GG Re: EMS Challenge what do her eyeballs do when she tenses up? ck In a message dated 01/06/11 20:14:47 Central Standard Time, amwoods8644@... writes: When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Assuming she will allow us, we should now do an evaluation of her cranial nerves. GG Re: EMS Challenge what do her eyeballs do when she tenses up? ck In a message dated 01/06/11 20:14:47 Central Standard Time, amwoods8644@... writes: When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 My instinct would say taste, because it's mostly smell, but ultimately, I don't know. Alyssa Woods, NREMT-B CPR Instructor > On Old Olympus Tipmost Top, A Finn and A German Viewed Some Hops.... > > which one is the most difficult to test? > > ck > > > In a message dated 01/06/11 20:28:52 Central Standard Time, > wegandy1938@... writes: > > Assuming she will allow us, we should now do an evaluation of her cranial > nerves. > > GG > > Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says > she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having > them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 My instinct would say taste, because it's mostly smell, but ultimately, I don't know. Alyssa Woods, NREMT-B CPR Instructor > On Old Olympus Tipmost Top, A Finn and A German Viewed Some Hops.... > > which one is the most difficult to test? > > ck > > > In a message dated 01/06/11 20:28:52 Central Standard Time, > wegandy1938@... writes: > > Assuming she will allow us, we should now do an evaluation of her cranial > nerves. > > GG > > Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says > she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having > them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 CN XIII and CN XI cause her to have attacks and dizziness. As your testing, the patient becomes increasingly anxious and repeatedly attempts to reassure her family that everything will be alright, and attempting to cue you to tell them similarly. Alyssa Woods, NREMT-B CPR Instructor Sent from the itty bitty keyboard on my iPhone > Assuming she will allow us, we should now do an evaluation of her cranial nerves. > > GG > > Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 CN XIII and CN XI cause her to have attacks and dizziness. As your testing, the patient becomes increasingly anxious and repeatedly attempts to reassure her family that everything will be alright, and attempting to cue you to tell them similarly. Alyssa Woods, NREMT-B CPR Instructor Sent from the itty bitty keyboard on my iPhone > Assuming she will allow us, we should now do an evaluation of her cranial nerves. > > GG > > Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 It's not pericarditis. Alyssa Woods, NREMT-B CPR Instructor > Paracarditis? > > Sent from my iPhone > > > > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > She seems entirely sure that she's fine, on the other hand. > > I like the direction you're going. Never forget the basics. > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > Lots of symptoms, few signs... > > Alyssa Woods, NREMT-B > CPR Instructor > > > > > Ok, I'll bite, on a strictly EMT-B level > > First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. > > Notify the parents to keep an eye on her, and call back if things get worse, > > If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. > > MAKE SURE to get the refusal signed by her before leaving. > > Chances are, you'll be back. > > The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. > > Otherwise, you cant even take a B/P without her permission. > > Coug. > > I'll keep my Guns, my Freedom and my MONEY, > You can keep the " CHANGE. " > > > > > Subject: EMS Challenge > To: texasems-l > Date: Thursday, January 6, 2011, 1:16 PM > > I think we're about due for another challenge, if anyone is up for it. > > You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. > > The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 It's not pericarditis. Alyssa Woods, NREMT-B CPR Instructor > Paracarditis? > > Sent from my iPhone > > > > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > She seems entirely sure that she's fine, on the other hand. > > I like the direction you're going. Never forget the basics. > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > Lots of symptoms, few signs... > > Alyssa Woods, NREMT-B > CPR Instructor > > > > > Ok, I'll bite, on a strictly EMT-B level > > First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. > > Notify the parents to keep an eye on her, and call back if things get worse, > > If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. > > MAKE SURE to get the refusal signed by her before leaving. > > Chances are, you'll be back. > > The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. > > Otherwise, you cant even take a B/P without her permission. > > Coug. > > I'll keep my Guns, my Freedom and my MONEY, > You can keep the " CHANGE. " > > > > > Subject: EMS Challenge > To: texasems-l > Date: Thursday, January 6, 2011, 1:16 PM > > I think we're about due for another challenge, if anyone is up for it. > > You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. > > The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 No trauma, no insect bite marks. Alyssa Woods, NREMT-B CPR Instructor > Is there any insect bite marks? > > Sent from my iPhone > > > > > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > > > She seems entirely sure that she's fine, on the other hand. > > > > I like the direction you're going. Never forget the basics. > > > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > > > Lots of symptoms, few signs... > > > > > > > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > > > > > > > > >> Ok, I'll bite, on a strictly EMT-B level > >> > >> First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. > >> > >> Notify the parents to keep an eye on her, and call back if things get worse, > >> > >> If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. > >> > >> MAKE SURE to get the refusal signed by her before leaving. > >> > >> Chances are, you'll be back. > >> > >> The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. > >> > >> Otherwise, you cant even take a B/P without her permission. > >> > >> Coug. > >> > >> I'll keep my Guns, my Freedom and my MONEY, > >> You can keep the " CHANGE. " > >> > >> > >> > >> > >> Subject: EMS Challenge > >> To: texasems-l > >> Date: Thursday, January 6, 2011, 1:16 PM > >> > >> > >> > >> I think we're about due for another challenge, if anyone is up for it. > >> > >> You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. > >> > >> The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. > >> > >> Alyssa Woods, NREMT-B > >> > >> CPR Instructor > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 No trauma, no insect bite marks. Alyssa Woods, NREMT-B CPR Instructor > Is there any insect bite marks? > > Sent from my iPhone > > > > > I was letting everyone go with the assumption that she was allowing you to check her out to humor her parents, and reassure them that she's okay. > > > > She seems entirely sure that she's fine, on the other hand. > > > > I like the direction you're going. Never forget the basics. > > > > When you question her further, she is quick to dismiss the shocks as " nothing " , " just a weird feeling in my head " , and then flat-out says she's just having headaches. If you're really paying attention, you will notice a relation between shocks and activity, - she claims that she's not having them anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, and nausea. Reflexes are on the low end of normal, and she seems to be experiencing some mild ataxia. > > > > Her parents are growing increasingly distressed, and believe thoroughly that this is not normal for her. > > > > Lots of symptoms, few signs... > > > > > > > > Alyssa Woods, NREMT-B > > CPR Instructor > > > > > > > > > > > >> Ok, I'll bite, on a strictly EMT-B level > >> > >> First, she is 18, if she refuses to go get checked out, you try to talk her into it, but if it fails, Get a signed refusal. > >> > >> Notify the parents to keep an eye on her, and call back if things get worse, > >> > >> If she's 18 y.o. and refusing medical treatment, there is really not much you can do about it, unless she passes out, then you have " Implied " consent. > >> > >> MAKE SURE to get the refusal signed by her before leaving. > >> > >> Chances are, you'll be back. > >> > >> The only other way to forcibly treat this patient would be to have Law Enforcement on scene, that is willing to place her under temporary arrest, known as " protective custody " an it would need to be documented, documented, documented. > >> > >> Otherwise, you cant even take a B/P without her permission. > >> > >> Coug. > >> > >> I'll keep my Guns, my Freedom and my MONEY, > >> You can keep the " CHANGE. " > >> > >> > >> > >> > >> Subject: EMS Challenge > >> To: texasems-l > >> Date: Thursday, January 6, 2011, 1:16 PM > >> > >> > >> > >> I think we're about due for another challenge, if anyone is up for it. > >> > >> You're dispatched to an 18 year old woman experiencing seizures. Upon arrival, you find a young woman who appears to be having a panic attack, and states that she experienced a few " shocks " . She's diaphoretic and tachycardic at a rate of 140 resting, with a blood pressure of 142/98, and a respiratory rate of 26. She has notable tremor. She reports no medical history, no medications, and no allergies, and her parents state that she's perfectly healthy, and couldn't be on drugs, as she's active in high school sports and is drug tested routinely. > >> > >> The patient states that she doesn't think that she's experiencing an emergency, and insists that her parents are overreacting and she simply wants to go back to bed. > >> > >> Alyssa Woods, NREMT-B > >> > >> CPR Instructor > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. There is no CN XIII. There are only 12 cranial nerves. About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. GG Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. There is no CN XIII. There are only 12 cranial nerves. About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. GG Re: EMS Challenge > > what do her eyeballs do when she tenses up? > > ck > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > amwoods8644@... writes: > > When you question her further, she is quick to dismiss the shocks as > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > having headaches. If you're really paying attention, you will notice a > relation between shocks and activity, - she claims that she's not having them > anymore, though every few minutes you notice her tense abruptly. > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > and nausea. Reflexes are on the low end of normal, and she seems to be > experiencing some mild ataxia. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 My apologies - that should be VIII. Movement of the head or neck causes her to have attacks. Her main concern, however, seems to be with how her family is handling this. Alyssa Woods, NREMT-B CPR Instructor > Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. > > More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. > > There is no CN XIII. There are only 12 cranial nerves. > > About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. > > GG > > Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 My apologies - that should be VIII. Movement of the head or neck causes her to have attacks. Her main concern, however, seems to be with how her family is handling this. Alyssa Woods, NREMT-B CPR Instructor > Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. > > More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. > > There is no CN XIII. There are only 12 cranial nerves. > > About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. > > GG > > Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Though, as a side-note, benzodiazepines might be a good idea, for the anxiety and the tremors. Alyssa Woods, NREMT-B CPR Instructor > Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. > > More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. > > There is no CN XIII. There are only 12 cranial nerves. > > About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. > > GG > > Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Though, as a side-note, benzodiazepines might be a good idea, for the anxiety and the tremors. Alyssa Woods, NREMT-B CPR Instructor > Well, trouble with CN XI makes some sense. This is the spinal accessory nerve. It is the only one of the spinal nerves that does not actually arise within the cranium. It controls the sternocleidomastoid and trapezius muscles and tongue movements. These can be tested by asking her to shrug her shoulders both with and without resistance. However, it is unlikely that paresthesia in an arm, for instance, would be caused by a problem with this nerve. > > More likely is a problem with the brachial plexus. These are spinal nerves arising from C5 through T1. A sprain in the muscles surrounding them could be putting pressure on and causing the paresthesia. Another possibility is thoracic outlet syndrone. Further, her spine needs to be x-rayed to rule out scoliosis and other spinal abnormalities. > > There is no CN XIII. There are only 12 cranial nerves. > > About all we can do for her is transport. She does not need oxygen nor spinal immobilization nor an IV. Pain treatment is probably not warranted. However, if her anxiety gets worse, a couple of mg of midazolam or valium might help. > > GG > > Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, now we're down to labyrinthine disorder. That would explain her dizziness and her ataxia. Still thinking that her tachycardia is due to anxiety. I must admit that I have not heard of a CN VIII problem causing paresthesia in an extremity, and I don't know how that could happen. Tracing the nerve tracts does not show any way that could happen. So, is it possible that two different things are going on here? An acute labyrinthine disorder coupled with a muscle strain causing compression of the brachial plexus nerves which is producing the paresthesia? There has to be some nerve tract involved in the paresthesia. Just a matter of tracking it down. I see that she is afraid that she is going to let herself and her family down if she cannot perform as an athlete, is scared about what may be happening, in denial and hoping it will just go away, and so forth. Some benzos or some phenothiazines (phenergan, compazine, thorazine) will help if she has a labyrinthine disorder and also help her calm down. GG Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, now we're down to labyrinthine disorder. That would explain her dizziness and her ataxia. Still thinking that her tachycardia is due to anxiety. I must admit that I have not heard of a CN VIII problem causing paresthesia in an extremity, and I don't know how that could happen. Tracing the nerve tracts does not show any way that could happen. So, is it possible that two different things are going on here? An acute labyrinthine disorder coupled with a muscle strain causing compression of the brachial plexus nerves which is producing the paresthesia? There has to be some nerve tract involved in the paresthesia. Just a matter of tracking it down. I see that she is afraid that she is going to let herself and her family down if she cannot perform as an athlete, is scared about what may be happening, in denial and hoping it will just go away, and so forth. Some benzos or some phenothiazines (phenergan, compazine, thorazine) will help if she has a labyrinthine disorder and also help her calm down. GG Re: EMS Challenge > > > > what do her eyeballs do when she tenses up? > > > > ck > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > amwoods8644@... writes: > > > > When you question her further, she is quick to dismiss the shocks as > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's just > > having headaches. If you're really paying attention, you will notice a > > relation between shocks and activity, - she claims that she's not having them > > anymore, though every few minutes you notice her tense abruptly. > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > and nausea. Reflexes are on the low end of normal, and she seems to be > > experiencing some mild ataxia. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 The paresthesia is mainly on her face, and it's something that she doesn't seem concerned about. Though, I wouldn't be surprised to see intermittent paresthesia in her fingers due to hyperventilation secondary to anxiety. Alyssa Woods, NREMT-B CPR Instructor > Well, now we're down to labyrinthine disorder. That would explain her dizziness and her ataxia. Still thinking that her tachycardia is due to anxiety. > > I must admit that I have not heard of a CN VIII problem causing paresthesia in an extremity, and I don't know how that could happen. Tracing the nerve tracts does not show any way that could happen. > > So, is it possible that two different things are going on here? An acute labyrinthine disorder coupled with a muscle strain causing compression of the brachial plexus nerves which is producing the paresthesia? There has to be some nerve tract involved in the paresthesia. Just a matter of tracking it down. > > I see that she is afraid that she is going to let herself and her family down if she cannot perform as an athlete, is scared about what may be happening, in denial and hoping it will just go away, and so forth. > > Some benzos or some phenothiazines (phenergan, compazine, thorazine) will help if she has a labyrinthine disorder and also help her calm down. > > GG > > Re: EMS Challenge > > > > > > what do her eyeballs do when she tenses up? > > > > > > ck > > > > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > > amwoods8644@... writes: > > > > > > When you question her further, she is quick to dismiss the shocks as > > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's > just > > > having headaches. If you're really paying attention, you will notice a > > > relation between shocks and activity, - she claims that she's not having > them > > > anymore, though every few minutes you notice her tense abruptly. > > > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > > and nausea. Reflexes are on the low end of normal, and she seems to be > > > experiencing some mild ataxia. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, that suggest's Bell's Palsy, a condition of CR VII. GG Re: EMS Challenge > > > > > > what do her eyeballs do when she tenses up? > > > > > > ck > > > > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > > amwoods8644@... writes: > > > > > > When you question her further, she is quick to dismiss the shocks as > > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's > just > > > having headaches. If you're really paying attention, you will notice a > > > relation between shocks and activity, - she claims that she's not having > them > > > anymore, though every few minutes you notice her tense abruptly. > > > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > > and nausea. Reflexes are on the low end of normal, and she seems to be > > > experiencing some mild ataxia. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Well, that suggest's Bell's Palsy, a condition of CR VII. GG Re: EMS Challenge > > > > > > what do her eyeballs do when she tenses up? > > > > > > ck > > > > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > > amwoods8644@... writes: > > > > > > When you question her further, she is quick to dismiss the shocks as > > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's > just > > > having headaches. If you're really paying attention, you will notice a > > > relation between shocks and activity, - she claims that she's not having > them > > > anymore, though every few minutes you notice her tense abruptly. > > > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > > and nausea. Reflexes are on the low end of normal, and she seems to be > > > experiencing some mild ataxia. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2011 Report Share Posted January 6, 2011 Nope. Alyssa Woods, NREMT-B CPR Instructor > Well, that suggest's Bell's Palsy, a condition of CR VII. > > GG > > Re: EMS Challenge > > > > > > > > what do her eyeballs do when she tenses up? > > > > > > > > ck > > > > > > > > > > > > In a message dated 01/06/11 20:14:47 Central Standard Time, > > > > amwoods8644@... writes: > > > > > > > > When you question her further, she is quick to dismiss the shocks as > > > > " nothing " , " just a weird feeling in my head " , and then flat-out says she's > > > just > > > > having headaches. If you're really paying attention, you will notice a > > > > relation between shocks and activity, - she claims that she's not having > > them > > > > anymore, though every few minutes you notice her tense abruptly. > > > > > > > > Detailed physical is normal, except for mild dizziness, fatigue, tremor, > > > > and nausea. Reflexes are on the low end of normal, and she seems to be > > > > experiencing some mild ataxia. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2011 Report Share Posted January 7, 2011 On Thursday, January 6, 2011 20:31, krin135@... said: > On Old Olympus Tipmost Top, A Finn and A German Viewed Some Hops.... Come on, Doc! I know you graduated well before political correctness, like I did. That's not the mnemonic I was taught! On the scenario, anything unusual about the patient's breath odour? Eating disorder? Excellent suggestion about separating the girl from her parents for further history taking. It often makes a huge difference. Rob Quote Link to comment Share on other sites More sharing options...
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