Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 please specify labs available, general work history (roustabout, roughneck, rigger, driller etc) and current weather conditions. ck In a message dated 07/13/11 12:17:44 Central Daylight Time, amwoods8644@... writes: In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 please specify labs available, general work history (roustabout, roughneck, rigger, driller etc) and current weather conditions. ck In a message dated 07/13/11 12:17:44 Central Daylight Time, amwoods8644@... writes: In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Since you requested it.... You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. HR 96 BP 142/90 RR 12 O2 99% In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. What do you want to know? And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. Alyssa Woods, NREMT-B > Agreed!! Do another one. That was fun! > > Christie Hale > ---- " Sharp wrote: > > Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > something to scratch our heads about while trying to figure out what was > > going on in your patient's head. > > > > Barry > > > > Barry Sharp, MSHP, MCHES > > Tobacco Prevention & Control Program Coordinator > > Substance Abuse Services Unit > > Mental Health and Substance Abuse Division > > > > > > > > Re: Mystery Diagnosis > > > >>>>>>>>>> > > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > > >> closest > > > >>>>> one so far. > > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > and > > > >>>>> focal. > > > >>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>> > > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > > >>>>> swollen lymph node > > > >>>>>>>>>> and one minor abrasion on her chin. > > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > > >>>>> jeremydriver@...> wrote: > > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > > >>>>> bradsattler@...> wrote: > > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > > >>>>> anyway)? > > > >>>>>>>>>>>>> -Brad > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > > >>>>> duration of the > > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > > feel > > > >> any > > > >>>>> other swollen > > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > > is > > > >> the > > > >>>>> node? > > > >>>>>>>>>> Reasesses paying attention for nodules? > > > >>>>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > > >>>>> amwoods8644@...> > > > >>>>>>>>>> wrote: > > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > > >> stop > > > >>>>> her seizures > > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > > >> normal > > > >>>>> treatment > > > >>>>>>>>>> for siezure until you know more. > > > >>>>>>>>>>>>>>> Henry > > > >>>>>>>>>>>>>>> Mystery Diagnosis > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > > in > > > >>>>> the yard, > > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > > her > > > >>>>> parents instantly > > > >>>>>>>>>> calm down and tell you she has no history, no medications, > > and > > > >> no > > > >>>>> known > > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > > >> has > > > >>>>> been going on > > > >>>>>>>>>> for at least 5 minutes. > > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >> ---------------------------------------------------------- > > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> ---------- > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Since you requested it.... You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. HR 96 BP 142/90 RR 12 O2 99% In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. What do you want to know? And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. Alyssa Woods, NREMT-B > Agreed!! Do another one. That was fun! > > Christie Hale > ---- " Sharp wrote: > > Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > something to scratch our heads about while trying to figure out what was > > going on in your patient's head. > > > > Barry > > > > Barry Sharp, MSHP, MCHES > > Tobacco Prevention & Control Program Coordinator > > Substance Abuse Services Unit > > Mental Health and Substance Abuse Division > > > > > > > > Re: Mystery Diagnosis > > > >>>>>>>>>> > > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > > >> closest > > > >>>>> one so far. > > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > and > > > >>>>> focal. > > > >>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>> > > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > > >>>>> swollen lymph node > > > >>>>>>>>>> and one minor abrasion on her chin. > > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > > >>>>> jeremydriver@...> wrote: > > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > > >>>>> bradsattler@...> wrote: > > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > > >>>>> anyway)? > > > >>>>>>>>>>>>> -Brad > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > > >>>>> duration of the > > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > > feel > > > >> any > > > >>>>> other swollen > > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > > is > > > >> the > > > >>>>> node? > > > >>>>>>>>>> Reasesses paying attention for nodules? > > > >>>>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > > >>>>> amwoods8644@...> > > > >>>>>>>>>> wrote: > > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > > >> stop > > > >>>>> her seizures > > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > > >> normal > > > >>>>> treatment > > > >>>>>>>>>> for siezure until you know more. > > > >>>>>>>>>>>>>>> Henry > > > >>>>>>>>>>>>>>> Mystery Diagnosis > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > > in > > > >>>>> the yard, > > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > > her > > > >>>>> parents instantly > > > >>>>>>>>>> calm down and tell you she has no history, no medications, > > and > > > >> no > > > >>>>> known > > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > > >> has > > > >>>>> been going on > > > >>>>>>>>>> for at least 5 minutes. > > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >> ---------------------------------------------------------- > > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> ---------- > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Since you requested it.... You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. HR 96 BP 142/90 RR 12 O2 99% In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. What do you want to know? And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. Alyssa Woods, NREMT-B > Agreed!! Do another one. That was fun! > > Christie Hale > ---- " Sharp wrote: > > Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > something to scratch our heads about while trying to figure out what was > > going on in your patient's head. > > > > Barry > > > > Barry Sharp, MSHP, MCHES > > Tobacco Prevention & Control Program Coordinator > > Substance Abuse Services Unit > > Mental Health and Substance Abuse Division > > > > > > > > Re: Mystery Diagnosis > > > >>>>>>>>>> > > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > > >> closest > > > >>>>> one so far. > > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > and > > > >>>>> focal. > > > >>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>> > > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > > >>>>> swollen lymph node > > > >>>>>>>>>> and one minor abrasion on her chin. > > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > > >>>>> jeremydriver@...> wrote: > > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > > >>>>> bradsattler@...> wrote: > > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > > >>>>> anyway)? > > > >>>>>>>>>>>>> -Brad > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > > >>>>> duration of the > > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > > feel > > > >> any > > > >>>>> other swollen > > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > > is > > > >> the > > > >>>>> node? > > > >>>>>>>>>> Reasesses paying attention for nodules? > > > >>>>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > > >>>>> amwoods8644@...> > > > >>>>>>>>>> wrote: > > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > > >> stop > > > >>>>> her seizures > > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > > >> normal > > > >>>>> treatment > > > >>>>>>>>>> for siezure until you know more. > > > >>>>>>>>>>>>>>> Henry > > > >>>>>>>>>>>>>>> Mystery Diagnosis > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > > in > > > >>>>> the yard, > > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > > her > > > >>>>> parents instantly > > > >>>>>>>>>> calm down and tell you she has no history, no medications, > > and > > > >> no > > > >>>>> known > > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > > >> has > > > >>>>> been going on > > > >>>>>>>>>> for at least 5 minutes. > > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >> ---------------------------------------------------------- > > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> ---------- > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 What is the worker's nationality/country of origin? Has he been there or traveled to, or worked, in any foreign countries recently? Previous medical history/meds/allergies? Temp? Skin color and appearance? Mark Pavey LP Re: Mystery Diagnosis > > >>>>>>>>>> > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > >> closest > > >>>>> one so far. > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > and > > >>>>> focal. > > >>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>> (21) 842-6428 > > >>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>>> > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > >>>>>>>>>>> > > >>>>>>>>>>> Excuse any errors. > > >>>>>>>>>>> Sent from my iPhone > > >>>>>>>>>>> > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > >>>>> amwoods8644@...> wrote: > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > >>>>> swollen lymph node > > >>>>>>>>>> and one minor abrasion on her chin. > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>>>> > > >>>>>>>>>>>> > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > >>>>>>>>>>>> > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > >>>>> jeremydriver@...> wrote: > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > >>>>>>>>>>>>> > > >>>>>>>>>>>>> Sent from my iPhone > > >>>>>>>>>>>>> > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > >>>>> bradsattler@...> wrote: > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > >>>>> anyway)? > > >>>>>>>>>>>>> -Brad > > >>>>>>>>>>>>> > > >>>>>>>>>>>>> Sent from my iPhone > > >>>>>>>>>>>>> > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > >>>>> amwoods8644@...> wrote: > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > >>>>> duration of the > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > feel > > >> any > > >>>>> other swollen > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>>>>>> > > >>>>>>>>>>>>>> > > >>>>>>>>>>>>>> > > >>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > is > > >> the > > >>>>> node? > > >>>>>>>>>> Reasesses paying attention for nodules? > > >>>>>>>>>>>>>>> Sent from my iPhone > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > >>>>> amwoods8644@...> > > >>>>>>>>>> wrote: > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > >> stop > > >>>>> her seizures > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > >> normal > > >>>>> treatment > > >>>>>>>>>> for siezure until you know more. > > >>>>>>>>>>>>>>> Henry > > >>>>>>>>>>>>>>> Mystery Diagnosis > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > in > > >>>>> the yard, > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > her > > >>>>> parents instantly > > >>>>>>>>>> calm down and tell you she has no history, no medications, > and > > >> no > > >>>>> known > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > >> has > > >>>>> been going on > > >>>>>>>>>> for at least 5 minutes. > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> > > >> ---------------------------------------------------------- > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > Release > > >>>>> Date: > > >>>>>>>>>> 07/11/11 18:35:00 > > >>>>>>>>>>>>>>> ---------- > > >>>>>>>>>>>>>>> > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > Release > > >>>>> Date: > > >>>>>>>>>> 07/11/11 18:35:00 > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? Sent from my iPhone McGee, EMT-P > Since you requested it.... > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > HR 96 > BP 142/90 > RR 12 > O2 99% > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > What do you want to know? > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > Alyssa Woods, NREMT-B > > > > > > > >> Agreed!! Do another one. That was fun! >> >> Christie Hale >> ---- " Sharp wrote: >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us >>> something to scratch our heads about while trying to figure out what was >>> going on in your patient's head. >>> >>> Barry >>> >>> Barry Sharp, MSHP, MCHES >>> Tobacco Prevention & Control Program Coordinator >>> Substance Abuse Services Unit >>> Mental Health and Substance Abuse Division >>> >>> >>> >>> Re: Mystery Diagnosis >>>>>>>>>>>>>> >>>>>>>>>>>>>> By which you mean metastatic cancer? No, but you're the >>>>>> closest >>>>>>>>> one so far. >>>>>>>>>>>>>> You're thinking along the right lines -- chronic, medical, >>> and >>>>>>>>> focal. >>>>>>>>>>>>>> Alyssa Woods, NREMT-B >>>>>>>>>>>>>> (21) 842-6428 >>>>>>>>>>>>>> >>>>>>>>>>>>>> >>>>>>>>>>>>>> >>>>>>>>>>>>>>> Could be mets ca? Just a thought.. >>>>>>>>>>>>>>> >>>>>>>>>>>>>>> Excuse any errors. >>>>>>>>>>>>>>> Sent from my iPhone >>>>>>>>>>>>>>> >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods >>>>>>>>> amwoods8644@...> wrote: >>>>>>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one >>>>>>>>> swollen lymph node >>>>>>>>>>>>>> and one minor abrasion on her chin. >>>>>>>>>>>>>>>> Alyssa Woods, NREMT-B >>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone >>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver >>>>>>>>> jeremydriver@...> wrote: >>>>>>>>>>>>>>>>> Cat-scratch encephalopathy? >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> Sent from my iPhone >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler >>>>>>>>> bradsattler@...> wrote: >>>>>>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check >>>>>>>>> anyway)? >>>>>>>>>>>>>>>>> -Brad >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> Sent from my iPhone >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods >>>>>>>>> amwoods8644@...> wrote: >>>>>>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the >>>>>>>>> duration of the >>>>>>>>>>>>>> drip only, the node is visibly swollen. You don't see or >>> feel >>>>>> any >>>>>>>>> other swollen >>>>>>>>>>>>>> lymph nodes. No s/s of anemia. >>>>>>>>>>>>>>>>>> Alyssa Woods, NREMT-B >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big >>> is >>>>>> the >>>>>>>>> node? >>>>>>>>>>>>>> Reasesses paying attention for nodules? >>>>>>>>>>>>>>>>>>> Sent from my iPhone >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods >>>>>>>>> amwoods8644@...> >>>>>>>>>>>>>> wrote: >>>>>>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital >>>>>> stop >>>>>>>>> her seizures >>>>>>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. >>>>>>>>>>>>>>>>>>> Alyssa Woods, NREMT-B >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your >>>>>> normal >>>>>>>>> treatment >>>>>>>>>>>>>> for siezure until you know more. >>>>>>>>>>>>>>>>>>> Henry >>>>>>>>>>>>>>>>>>> Mystery Diagnosis >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing >>> in >>>>>>>>> the yard, >>>>>>>>>>>>>> when she suddenly had a seizure. When you arrive on scene >>> her >>>>>>>>> parents instantly >>>>>>>>>>>>>> calm down and tell you she has no history, no medications, >>> and >>>>>> no >>>>>>>>> known >>>>>>>>>>>>>> allergies. Your patient is having a grand mal seizure which >>>>>> has >>>>>>>>> been going on >>>>>>>>>>>>>> for at least 5 minutes. >>>>>>>>>>>>>>>>>>> What's your treatment and what's happening to her? >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> Alyssa Woods, NREMT-B >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> >>>>>> ---------------------------------------------------------- >>>>>>>>>>>>>>>>>>> No virus found in this incoming message. >>>>>>>>>>>>>>>>>>> Checked by AVG - www.avg.com >>>>>>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - >>> Release >>>>>>>>> Date: >>>>>>>>>>>>>> 07/11/11 18:35:00 >>>>>>>>>>>>>>>>>>> ---------- >>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>> No virus found in this outgoing message. >>>>>>>>>>>>>>>>>>> Checked by AVG - www.avg.com >>>>>>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - >>> Release >>>>>>>>> Date: >>>>>>>>>>>>>> 07/11/11 18:35:00 >>>>>>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 what color are his irises? any odd rings around them? ck In a message dated 07/14/11 08:39:10 Central Daylight Time, amwoods8644@... writes: No splenomegaly. No ruddy complexion. Alyssa Woods, NREMT-B (210) 842-6428 Sent from the itty bitty keyboard on my iPhone > Any splenomegaly? Ruddy complexion? > > Wes > > Sent from my iPad > > > > > First temp: 99.9 > > Second: 100.1 > > > > Alyssa Woods, NREMT-B > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > Temperature? > > > > > > Wes > > > > > > On the move from my iPhone > > > > > > On Jul 14, 2011, at 8:20, Alyssa Woods amwoods8644@...> wrote: > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > > > > > CBC: > > > > Hemoglobin-----17 *H > > > > Hematocrit-------52 *H > > > > RBC---------------5.2 > > > > MCV---------------100 > > > > MCH---------------32.7 > > > > MCHC-------------32.7 > > > > Platelets----------276 000 > > > > WBC---------------11 000 *H > > > > > > > > BMP: > > > > Glucose-----------89 > > > > BUN----------------18 > > > > Creatinine---------1.11 > > > > Ca------------------9.6 > > > > NaCl---------------138 > > > > K-------------------4.8 > > > > Cl------------------105 > > > > CO2---------------24 > > > > Albumin----------4.1 > > > > Total Protein----7.6 > > > > ALP---------------39 > > > > ALT---------------20 > > > > AST---------------20 > > > > Bilirubin, Direct--0.6 > > > > Total Serum Iron-32 *H > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > > > > > Sent from my iPhone > > > > > McGee, EMT-P > > > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods amwoods8644@...> wrote: > > > > > > > > > > > Since you requested it.... > > > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > > > HR 96 > > > > > > BP 142/90 > > > > > > RR 12 > > > > > > O2 99% > > > > > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > > > What do you want to know? > > > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > > >> > > > > > >> Christie Hale > > > > > >> ---- " Sharp wrote: > > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > > > >>> something to scratch our heads about while trying to figure out what was > > > > > >>> going on in your patient's head. > > > > > >>> > > > > > >>> Barry > > > > > >>> > > > > > >>> Barry Sharp, MSHP, MCHES > > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > > >>> Substance Abuse Services Unit > > > > > >>> Mental Health and Substance Abuse Division > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>> -----Original Message----- > > > > > >>> From: texasems-l [mailto:texasems-l ] On > > > > > >>> Behalf Of Alyssa Woods > > > > > >>> Sent: Wednesday, July 13, 2011 11:20 AM > > > > > >>> To: texasems-l > > > > > >>> Subject: Re: Mystery Diagnosis > > > > > >>> > > > > > >>> Congratulations, ! > > > > > >>> > > > > > >>> She had an Cerebral AV Malformation -- her arteries and veins had grown > > > > > >>> together to the point where it created an ischemic area in her brain > > > > > >>> (hence why I would've accepted ischemic stroke or CVA -- something I > > > > > >>> would expect in older patients). For some reason, it was this day that > > > > > >>> she became symptomatic. > > > > > >>> > > > > > >>> In actuality, she was taken to the closest facility, and immediately > > > > > >>> transported out (via ground ambulance, as air ambulances were > > > > > >>> unavailable), to a facility with pediatric neurosurgery capabilities. > > > > > >>> > > > > > >>> > > > > > >>> Way to go, ! You win the only thing better than getting a prize > > > > > >>> from me -- NOT getting a prize from me! > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>> Alyssa Woods, NREMT-B > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>>> Uuummm... dialyze them? > > > > > >>>> > > > > > >>>> Are you suggesting an AV malformation or fistula of some sort, that > > > > > >>> can > > > > > >>>> be corrected with surgery? > > > > > >>>> > > > > > >>>> > > > > > >>>>> No, but you're definitely on the right track. Keep thinking along > > > > > >>> vasculature lines. > > > > > >>>>> > > > > > >>>>> What do we do to dialysis patients? > > > > > >>>>> > > > > > >>>>> Alyssa Woods, NREMT-B > > > > > >>>>> > > > > > >>>>> > > > > > >>>>> > > > > > >>>>> > > > > > >>>>> > > > > > >>>>> > > > > > >>>>>> Cerebral Aneurysms? > > > > > >>>>>> > > > > > >>>>>> Barry Sharp, MSHP, MCHES > > > > > >>>>>> Tobacco Prevention& Control Program Coordinator > > > > > >>>>>> Substance Abuse Services Unit > > > > > >>>>>> Mental Health and Substance Abuse Division > > > > > >>>>>> > > > > > >>>>>> > > > > > >>>>>> > > > > > >>>>>> -----Original Message----- > > > > > >>>>>> From: texasems-l > > > > > >>> [mailto:texasems-l ] On > > > > > >>>>>> Behalf Of Alyssa Woods > > > > > >>>>>> Sent: Wednesday, July 13, 2011 10:35 AM > > > > > >>>>>> To: texasems-l > > > > > >>>>>> Subject: Re: Mystery Diagnosis > > > > > >>>>>> > > > > > >>>>>> No and no. > > > > > >>>>>> > > > > > >>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>> > > > > > >>>>>> > > > > > >>>>>> > > > > > >>>>>> > > > > > >>>>>>> Alzheimer's or Parkinson's come to mind for much older patients. > > > > > >>>>>>> > > > > > >>>>>>> Wes > > > > > >>>>>>> > > > > > >>>>>>> On the move from my iPhone > > > > > >>>>>>> > > > > > >>>>>>> On Jul 13, 2011, at 10:31, Alyssa Woodsamwoods8644@...> > > > > > >>> wrote: > > > > > >>>>>>> > > > > > >>>>>>>> Ok, let's try some direction. > > > > > >>>>>>>> > > > > > >>>>>>>> A seizure can be a sign of: > > > > > >>>>>>>> > > > > > >>>>>>>> Exposure (Organophosphates (esp in children, when this is > > > > > >>> typically > > > > > >>>>>> the first sign), chemicals) > > > > > >>>>>>>> Trauma > > > > > >>>>>>>> Head Injury / ICH > > > > > >>>>>>>> Medical Problems > > > > > >>>>>>>> Localized problems > > > > > >>>>>>>> Meningitis > > > > > >>>>>>>> Epilepsy > > > > > >>>>>>>> Space-Occupying Lesions > > > > > >>>>>>>> Cancer / Tumors > > > > > >>>>>>>> Systemic problems > > > > > >>>>>>>> Electrolyte Imbalances > > > > > >>>>>>>> pH problems > > > > > >>>>>>>> Hypoglycemia > > > > > >>>>>>>> Hypoxia > > > > > >>>>>>>> Sepsis > > > > > >>>>>>>> Metastatic CA > > > > > >>>>>>>> Sickle Cell > > > > > >>>>>>>> > > > > > >>>>>>>> So we know it's a localized problem; something confined to the > > > > > >>>>>> brain. What else can cause issues? > > > > > >>>>>>>> What might we expect in someone who is 15 times her age? > > > > > >>>>>>>> > > > > > >>>>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>>>> (210) 842-6428 > > > > > >>>>>>>> > > > > > >>>>>>>> > > > > > >>>>>>>> > > > > > >>>>>>>> > > > > > >>>>>>>> > > > > > >>>>>>>>> Dehydration? > > > > > >>>>>>>>> > > > > > >>>>>>>>> Barry Sharp, MSHP, MCHES > > > > > >>>>>>>>> Tobacco Prevention& Control Program Coordinator > > > > > >>>>>>>>> Substance Abuse Services Unit > > > > > >>>>>>>>> Mental Health and Substance Abuse Division > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>> Re: Mystery Diagnosis > > > > > >>>>>>>>> > > > > > >>>>>>>>> No abnormal ammonia levels. > > > > > >>>>>>>>> > > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > > > >>> previous > > > > > >>>>>> viral > > > > > >>>>>>>>> infection or some congenital defect. > > > > > >>>>>>>>>> Sent from my iPhone > > > > > >>>>>>>>>> McGee, EMT-P > > > > > >>>>>>>>>> > > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > > >>> Woodsamwoods8644@...> > > > > > >>>>>>>>> wrote: > > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > > >>>>>>>>>>> No infection. > > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>>>>>>> (21) 842-6428 > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > > >>>>>>>>>>>> > > > > > >>>>>>>>>>>> Excuse any errors. > > > > > >>>>>>>>>>>> Sent from my iPhone > > > > > >>>>>>>>>>>> > > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > > >>>>>> amwoods8644@...> > > > > > >>>>>>>>> wrote: > > > > > >>> > > > > [Non-text portions of this message have been removed] > > > > > > [Non-text portions of this message have been removed] > > [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 ok...so how much does the patient smoke? and how much Nyquel did he bring on board? ck In a message dated 07/14/11 08:21:53 Central Daylight Time, amwoods8644@... writes: CBC: Hemoglobin-----17 *H Hematocrit-------52 *H RBC---------------5.2 MCV---------------100 MCH---------------32.7 MCHC-------------32.7 Platelets----------276 000 WBC---------------11 000 *H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. General impression is that he looks slightly fatigued but otherwise unremarkable. CBC: Hemoglobin-----17 *H Hematocrit-------52 *H RBC---------------5.2 MCV---------------100 MCH---------------32.7 MCHC-------------32.7 Platelets----------276 000 WBC---------------11 000 *H BMP: Glucose-----------89 BUN----------------18 Creatinine---------1.11 Ca------------------9.6 NaCl---------------138 K-------------------4.8 Cl------------------105 CO2---------------24 Albumin----------4.1 Total Protein----7.6 ALP---------------39 ALT---------------20 AST---------------20 Bilirubin, Direct--0.6 Total Serum Iron-32 *H Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > Sent from my iPhone > McGee, EMT-P > > > > > Since you requested it.... > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > HR 96 > > BP 142/90 > > RR 12 > > O2 99% > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > What do you want to know? > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > >> > >> Christie Hale > >> ---- " Sharp wrote: > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > >>> something to scratch our heads about while trying to figure out what was > >>> going on in your patient's head. > >>> > >>> Barry > >>> > >>> Barry Sharp, MSHP, MCHES > >>> Tobacco Prevention & Control Program Coordinator > >>> Substance Abuse Services Unit > >>> Mental Health and Substance Abuse Division > >>> > >>> > >>> > >>> Re: Mystery Diagnosis > >>>>>>>>>>>>>> > >>>>>>>>>>>>>> By which you mean metastatic cancer? No, but you're the > >>>>>> closest > >>>>>>>>> one so far. > >>>>>>>>>>>>>> You're thinking along the right lines -- chronic, medical, > >>> and > >>>>>>>>> focal. > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>>>>>>>> (21) 842-6428 > >>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Temperature? Wes On the move from my iPhone > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > CBC: > Hemoglobin-----17 *H > Hematocrit-------52 *H > RBC---------------5.2 > MCV---------------100 > MCH---------------32.7 > MCHC-------------32.7 > Platelets----------276 000 > WBC---------------11 000 *H > > BMP: > Glucose-----------89 > BUN----------------18 > Creatinine---------1.11 > Ca------------------9.6 > NaCl---------------138 > K-------------------4.8 > Cl------------------105 > CO2---------------24 > Albumin----------4.1 > Total Protein----7.6 > ALP---------------39 > ALT---------------20 > AST---------------20 > Bilirubin, Direct--0.6 > Total Serum Iron-32 *H > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > Sent from my iPhone > > McGee, EMT-P > > > > > > > > > Since you requested it.... > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > HR 96 > > > BP 142/90 > > > RR 12 > > > O2 99% > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > What do you want to know? > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > >> > > >> Christie Hale > > >> ---- " Sharp wrote: > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > >>> something to scratch our heads about while trying to figure out what was > > >>> going on in your patient's head. > > >>> > > >>> Barry > > >>> > > >>> Barry Sharp, MSHP, MCHES > > >>> Tobacco Prevention & Control Program Coordinator > > >>> Substance Abuse Services Unit > > >>> Mental Health and Substance Abuse Division > > >>> > > >>> > > >>> > > >>> Re: Mystery Diagnosis > > >>>>>>>>>>>>>> > > >>>>>>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > >>>>>> closest > > >>>>>>>>> one so far. > > >>>>>>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > >>> and > > >>>>>>>>> focal. > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > >>>>>>>>>>>>>> (21) 842-6428 > > >>>>>>>>>>>>>> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 First temp: 99.9 Second: 100.1 Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > Temperature? > > Wes > > On the move from my iPhone > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > CBC: > > Hemoglobin-----17 *H > > Hematocrit-------52 *H > > RBC---------------5.2 > > MCV---------------100 > > MCH---------------32.7 > > MCHC-------------32.7 > > Platelets----------276 000 > > WBC---------------11 000 *H > > > > BMP: > > Glucose-----------89 > > BUN----------------18 > > Creatinine---------1.11 > > Ca------------------9.6 > > NaCl---------------138 > > K-------------------4.8 > > Cl------------------105 > > CO2---------------24 > > Albumin----------4.1 > > Total Protein----7.6 > > ALP---------------39 > > ALT---------------20 > > AST---------------20 > > Bilirubin, Direct--0.6 > > Total Serum Iron-32 *H > > > > Alyssa Woods, NREMT-B > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > Sent from my iPhone > > > McGee, EMT-P > > > > > > > > > > > > > Since you requested it.... > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > HR 96 > > > > BP 142/90 > > > > RR 12 > > > > O2 99% > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > What do you want to know? > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > >> > > > >> Christie Hale > > > >> ---- " Sharp wrote: > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > >>> something to scratch our heads about while trying to figure out what was > > > >>> going on in your patient's head. > > > >>> > > > >>> Barry > > > >>> > > > >>> Barry Sharp, MSHP, MCHES > > > >>> Tobacco Prevention & Control Program Coordinator > > > >>> Substance Abuse Services Unit > > > >>> Mental Health and Substance Abuse Division > > > >>> > > > >>> > > > >>> > > > >>> Re: Mystery Diagnosis > > > >>>>>>>>> > > > >>>>>>>>> No abnormal ammonia levels. > > > >>>>>>>>> > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>> > > > >>>>>>>>> > > > >>>>>>>>> > > > >>>>>>>>> > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > >>> previous > > > >>>>>> viral > > > >>>>>>>>> infection or some congenital defect. > > > >>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>> McGee, EMT-P > > > >>>>>>>>>> > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > >>> Woodsamwoods8644@...> > > > >>>>>>>>> wrote: > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > >>>>>>>>>>> No infection. > > > >>>>>>>>>>> No leukemia or sickle cell. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>>> > > > >>>>>>>>>>> > > > >>>>>>>>>>> > > > >>>>>>>>>>> > > > >>>>>>>>>>> > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > >>>>>> amwoods8644@...> > > > >>>>>>>>> wrote: > > > >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Any bronzing of the skin, or can you tell since he's a rig worker? Thanks, CSS Re: Mystery Diagnosis > >>>>>>>>>>>>>> > >>>>>>>>>>>>>> By which you mean metastatic cancer? No, but you're the > >>>>>> closest > >>>>>>>>> one so far. > >>>>>>>>>>>>>> You're thinking along the right lines -- chronic, medical, > >>> and > >>>>>>>>> focal. > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>>>>>>>> (21) 842-6428 > >>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Any splenomegaly? Ruddy complexion? Wes Sent from my iPad > First temp: 99.9 > Second: 100.1 > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > > > Temperature? > > > > Wes > > > > On the move from my iPhone > > > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > > > CBC: > > > Hemoglobin-----17 *H > > > Hematocrit-------52 *H > > > RBC---------------5.2 > > > MCV---------------100 > > > MCH---------------32.7 > > > MCHC-------------32.7 > > > Platelets----------276 000 > > > WBC---------------11 000 *H > > > > > > BMP: > > > Glucose-----------89 > > > BUN----------------18 > > > Creatinine---------1.11 > > > Ca------------------9.6 > > > NaCl---------------138 > > > K-------------------4.8 > > > Cl------------------105 > > > CO2---------------24 > > > Albumin----------4.1 > > > Total Protein----7.6 > > > ALP---------------39 > > > ALT---------------20 > > > AST---------------20 > > > Bilirubin, Direct--0.6 > > > Total Serum Iron-32 *H > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > > > Sent from my iPhone > > > > McGee, EMT-P > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods amwoods8644@...> wrote: > > > > > > > > > Since you requested it.... > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > HR 96 > > > > > BP 142/90 > > > > > RR 12 > > > > > O2 99% > > > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > What do you want to know? > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > >> > > > > >> Christie Hale > > > > >> ---- " Sharp wrote: > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > > >>> something to scratch our heads about while trying to figure out what was > > > > >>> going on in your patient's head. > > > > >>> > > > > >>> Barry > > > > >>> > > > > >>> Barry Sharp, MSHP, MCHES > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > >>> Substance Abuse Services Unit > > > > >>> Mental Health and Substance Abuse Division > > > > >>> > > > > >>> > > > > >>> > > > > >>> Re: Mystery Diagnosis > > > > >>>>>>>>> > > > > >>>>>>>>> No abnormal ammonia levels. > > > > >>>>>>>>> > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > >>>>>>>>> > > > > >>>>>>>>> > > > > >>>>>>>>> > > > > >>>>>>>>> > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > > >>> previous > > > > >>>>>> viral > > > > >>>>>>>>> infection or some congenital defect. > > > > >>>>>>>>>> Sent from my iPhone > > > > >>>>>>>>>> McGee, EMT-P > > > > >>>>>>>>>> > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > >>> Woodsamwoods8644@...> > > > > >>>>>>>>> wrote: > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > >>>>>>>>>>> No infection. > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > >>>>>>>>>>> > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > >>>>>>>>>>> (21) 842-6428 > > > > >>>>>>>>>>> > > > > >>>>>>>>>>> > > > > >>>>>>>>>>> > > > > >>>>>>>>>>> > > > > >>>>>>>>>>> > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > >>>>>>>>>>>> > > > > >>>>>>>>>>>> Excuse any errors. > > > > >>>>>>>>>>>> Sent from my iPhone > > > > >>>>>>>>>>>> > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > >>>>>> amwoods8644@...> > > > > >>>>>>>>> wrote: > > > > >>> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 No splenomegaly. No ruddy complexion. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > Any splenomegaly? Ruddy complexion? > > Wes > > Sent from my iPad > > > > > First temp: 99.9 > > Second: 100.1 > > > > Alyssa Woods, NREMT-B > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > Temperature? > > > > > > Wes > > > > > > On the move from my iPhone > > > > > > > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > > > > > CBC: > > > > Hemoglobin-----17 *H > > > > Hematocrit-------52 *H > > > > RBC---------------5.2 > > > > MCV---------------100 > > > > MCH---------------32.7 > > > > MCHC-------------32.7 > > > > Platelets----------276 000 > > > > WBC---------------11 000 *H > > > > > > > > BMP: > > > > Glucose-----------89 > > > > BUN----------------18 > > > > Creatinine---------1.11 > > > > Ca------------------9.6 > > > > NaCl---------------138 > > > > K-------------------4.8 > > > > Cl------------------105 > > > > CO2---------------24 > > > > Albumin----------4.1 > > > > Total Protein----7.6 > > > > ALP---------------39 > > > > ALT---------------20 > > > > AST---------------20 > > > > Bilirubin, Direct--0.6 > > > > Total Serum Iron-32 *H > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > > > > > Sent from my iPhone > > > > > McGee, EMT-P > > > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods amwoods8644@...> wrote: > > > > > > > > > > > Since you requested it.... > > > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > > > HR 96 > > > > > > BP 142/90 > > > > > > RR 12 > > > > > > O2 99% > > > > > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > > > What do you want to know? > > > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > > >> > > > > > >> Christie Hale > > > > > >> ---- " Sharp wrote: > > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > > > >>> something to scratch our heads about while trying to figure out what was > > > > > >>> going on in your patient's head. > > > > > >>> > > > > > >>> Barry > > > > > >>> > > > > > >>> Barry Sharp, MSHP, MCHES > > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > > >>> Substance Abuse Services Unit > > > > > >>> Mental Health and Substance Abuse Division > > > > > >>> > > > > > >>> > > > > > >>> > > > > > >>> Re: Mystery Diagnosis > > > > > >>>>>>>>> > > > > > >>>>>>>>> No abnormal ammonia levels. > > > > > >>>>>>>>> > > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>> > > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > > > >>> previous > > > > > >>>>>> viral > > > > > >>>>>>>>> infection or some congenital defect. > > > > > >>>>>>>>>> Sent from my iPhone > > > > > >>>>>>>>>> McGee, EMT-P > > > > > >>>>>>>>>> > > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > > >>> Woodsamwoods8644@...> > > > > > >>>>>>>>> wrote: > > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > > >>>>>>>>>>> No infection. > > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > > >>>>>>>>>>> (21) 842-6428 > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>> > > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > > >>>>>>>>>>>> > > > > > >>>>>>>>>>>> Excuse any errors. > > > > > >>>>>>>>>>>> Sent from my iPhone > > > > > >>>>>>>>>>>> > > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > > >>>>>> amwoods8644@...> > > > > > >>>>>>>>> wrote: > > > > > >>> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Kind of eliminates polycythemia. Wes Sent from my iPad > No splenomegaly. > No ruddy complexion. > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > > > Any splenomegaly? Ruddy complexion? > > > > Wes > > > > Sent from my iPad > > > > > > > > > First temp: 99.9 > > > Second: 100.1 > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > Temperature? > > > > > > > > Wes > > > > > > > > On the move from my iPhone > > > > > > > > > > > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > > > > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > > > > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > > > > > > > CBC: > > > > > Hemoglobin-----17 *H > > > > > Hematocrit-------52 *H > > > > > RBC---------------5.2 > > > > > MCV---------------100 > > > > > MCH---------------32.7 > > > > > MCHC-------------32.7 > > > > > Platelets----------276 000 > > > > > WBC---------------11 000 *H > > > > > > > > > > BMP: > > > > > Glucose-----------89 > > > > > BUN----------------18 > > > > > Creatinine---------1.11 > > > > > Ca------------------9.6 > > > > > NaCl---------------138 > > > > > K-------------------4.8 > > > > > Cl------------------105 > > > > > CO2---------------24 > > > > > Albumin----------4.1 > > > > > Total Protein----7.6 > > > > > ALP---------------39 > > > > > ALT---------------20 > > > > > AST---------------20 > > > > > Bilirubin, Direct--0.6 > > > > > Total Serum Iron-32 *H > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > > > > > > > Sent from my iPhone > > > > > > McGee, EMT-P > > > > > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods amwoods8644@...> wrote: > > > > > > > > > > > > > Since you requested it.... > > > > > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > > > > > HR 96 > > > > > > > BP 142/90 > > > > > > > RR 12 > > > > > > > O2 99% > > > > > > > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > > > > > What do you want to know? > > > > > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > > > >> > > > > > > >> Christie Hale > > > > > > >> ---- " Sharp wrote: > > > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > > > > >>> something to scratch our heads about while trying to figure out what was > > > > > > >>> going on in your patient's head. > > > > > > >>> > > > > > > >>> Barry > > > > > > >>> > > > > > > >>> Barry Sharp, MSHP, MCHES > > > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > > > >>> Substance Abuse Services Unit > > > > > > >>> Mental Health and Substance Abuse Division > > > > > > >>> > > > > > > >>> > > > > > > >>> > > > > > > >>> Re: Mystery Diagnosis > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> No abnormal ammonia levels. > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > > > > >>> previous > > > > > > >>>>>> viral > > > > > > >>>>>>>>> infection or some congenital defect. > > > > > > >>>>>>>>>> Sent from my iPhone > > > > > > >>>>>>>>>> McGee, EMT-P > > > > > > >>>>>>>>>> > > > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > > > >>> Woodsamwoods8644@...> > > > > > > >>>>>>>>> wrote: > > > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > > > >>>>>>>>>>> No infection. > > > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > > > >>>>>>>>>>> (21) 842-6428 > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > > > >>>>>>>>>>>> > > > > > > >>>>>>>>>>>> Excuse any errors. > > > > > > >>>>>>>>>>>> Sent from my iPhone > > > > > > >>>>>>>>>>>> > > > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > > > >>>>>> amwoods8644@...> > > > > > > >>>>>>>>> wrote: > > > > > > >>> > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 that is a change. Many of the old off shore workers used to stock up on Nyquel because booze was banned... ck In a message dated 07/14/11 12:35:22 Central Daylight Time, amwoods8644@... writes: Pt denies smoking or drug use. Both are contraband on the vessel; all medications, even OTC, must go through you. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > ok...so how much does the patient smoke? > > and how much Nyquel did he bring on board? > > ck > > > In a message dated 07/14/11 08:21:53 Central Daylight Time, > amwoods8644@... writes: > > CBC: > Hemoglobin-----17 *H > Hematocrit-------52 *H > RBC---------------5.2 > MCV---------------100 > MCH---------------32.7 > MCHC-------------32.7 > Platelets----------276 000 > WBC---------------11 000 *H > > [Non-text portions of this message have been removed] > > [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Which type of polycythemia - absolute or relative? And you're chasing the wrong zebra. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > Kind of eliminates polycythemia. > > Wes > > Sent from my iPad > > > > > No splenomegaly. > > No ruddy complexion. > > > > Alyssa Woods, NREMT-B > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > Any splenomegaly? Ruddy complexion? > > > > > > Wes > > > > > > Sent from my iPad > > > > > > > > > > > > > First temp: 99.9 > > > > Second: 100.1 > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > Temperature? > > > > > > > > > > Wes > > > > > > > > > > On the move from my iPhone > > > > > > > > > > > > > > > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no allergies, no medications. > > > > > > > > > > > > Labs are unremarkable except for an elevated H&H, slightly elevated WBC, and elevated iron levels. > > > > > > > > > > > > General impression is that he looks slightly fatigued but otherwise unremarkable. > > > > > > > > > > > > CBC: > > > > > > Hemoglobin-----17 *H > > > > > > Hematocrit-------52 *H > > > > > > RBC---------------5.2 > > > > > > MCV---------------100 > > > > > > MCH---------------32.7 > > > > > > MCHC-------------32.7 > > > > > > Platelets----------276 000 > > > > > > WBC---------------11 000 *H > > > > > > > > > > > > BMP: > > > > > > Glucose-----------89 > > > > > > BUN----------------18 > > > > > > Creatinine---------1.11 > > > > > > Ca------------------9.6 > > > > > > NaCl---------------138 > > > > > > K-------------------4.8 > > > > > > Cl------------------105 > > > > > > CO2---------------24 > > > > > > Albumin----------4.1 > > > > > > Total Protein----7.6 > > > > > > ALP---------------39 > > > > > > ALT---------------20 > > > > > > AST---------------20 > > > > > > Bilirubin, Direct--0.6 > > > > > > Total Serum Iron-32 *H > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical history and last oral intake? > > > > > > > > > > > > > > Sent from my iPhone > > > > > > > McGee, EMT-P > > > > > > > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods amwoods8644@...> wrote: > > > > > > > > > > > > > > > Since you requested it.... > > > > > > > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 hours away, and that is an airlift which should be reserved for dire emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > > > > > > > HR 96 > > > > > > > > BP 142/90 > > > > > > > > RR 12 > > > > > > > > O2 99% > > > > > > > > > > > > > > > > In addition to your normal capabilities, you have some lab capabilities, IV antibiotics, and some more advanced drugs. However, because you're alone, you not only need to know what he has, but how to treat him for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > > > > > > > What do you want to know? > > > > > > > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, and no you can't answer it! The same goes for anyone who has worked with me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > > > > >> > > > > > > > >> Christie Hale > > > > > > > >> ---- " Sharp wrote: > > > > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks for giving us > > > > > > > >>> something to scratch our heads about while trying to figure out what was > > > > > > > >>> going on in your patient's head. > > > > > > > >>> > > > > > > > >>> Barry > > > > > > > >>> > > > > > > > >>> Barry Sharp, MSHP, MCHES > > > > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > > > > >>> Substance Abuse Services Unit > > > > > > > >>> Mental Health and Substance Abuse Division > > > > > > > >>> > > > > > > > >>> > > > > > > > >>> > > > > > > > >>> Re: Mystery Diagnosis > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>> No abnormal ammonia levels. > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>> > > > > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due to a > > > > > > > >>> previous > > > > > > > >>>>>> viral > > > > > > > >>>>>>>>> infection or some congenital defect. > > > > > > > >>>>>>>>>> Sent from my iPhone > > > > > > > >>>>>>>>>> McGee, EMT-P > > > > > > > >>>>>>>>>> > > > > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > > > > >>> Woodsamwoods8644@...> > > > > > > > >>>>>>>>> wrote: > > > > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > > > > >>>>>>>>>>> No infection. > > > > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > > > > >>>>>>>>>>> (21) 842-6428 > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>> > > > > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > > > > >>>>>>>>>>>> > > > > > > > >>>>>>>>>>>> Excuse any errors. > > > > > > > >>>>>>>>>>>> Sent from my iPhone > > > > > > > >>>>>>>>>>>> > > > > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > > > > >>>>>> amwoods8644@...> > > > > > > > >>>>>>>>> wrote: > > > > > > > >>> > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 No golden rings around the irises that you can see. His eyes are brown. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > what color are his irises? any odd rings around them? > > ck > > > In a message dated 07/14/11 08:39:10 Central Daylight Time, > amwoods8644@... writes: > > No splenomegaly. > No ruddy complexion. > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > > > Any splenomegaly? Ruddy complexion? > > > > Wes > > > > Sent from my iPad > > > > > > > > > First temp: 99.9 > > > Second: 100.1 > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > Temperature? > > > > > > > > Wes > > > > > > > > On the move from my iPhone > > > > > > > > On Jul 14, 2011, at 8:20, Alyssa Woods amwoods8644@...> > wrote: > > > > > > > > > No skin turgor. He ate last night. It's about 0900. No history, no > allergies, no medications. > > > > > > > > > > Labs are unremarkable except for an elevated H&H, slightly > elevated WBC, and elevated iron levels. > > > > > > > > > > General impression is that he looks slightly fatigued but > otherwise unremarkable. > > > > > > > > > > CBC: > > > > > Hemoglobin-----17 *H > > > > > Hematocrit-------52 *H > > > > > RBC---------------5.2 > > > > > MCV---------------100 > > > > > MCH---------------32.7 > > > > > MCHC-------------32.7 > > > > > Platelets----------276 000 > > > > > WBC---------------11 000 *H > > > > > > > > > > BMP: > > > > > Glucose-----------89 > > > > > BUN----------------18 > > > > > Creatinine---------1.11 > > > > > Ca------------------9.6 > > > > > NaCl---------------138 > > > > > K-------------------4.8 > > > > > Cl------------------105 > > > > > CO2---------------24 > > > > > Albumin----------4.1 > > > > > Total Protein----7.6 > > > > > ALP---------------39 > > > > > ALT---------------20 > > > > > AST---------------20 > > > > > Bilirubin, Direct--0.6 > > > > > Total Serum Iron-32 *H > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > > > > > > > > > > > > > > > Skin turgor? General appearance? Results of CBC and CMP? Medical > history and last oral intake? > > > > > > > > > > > > Sent from my iPhone > > > > > > McGee, EMT-P > > > > > > > > > > > > On Jul 13, 2011, at 12:17 PM, Alyssa Woods > amwoods8644@...> wrote: > > > > > > > > > > > > > Since you requested it.... > > > > > > > > > > > > > > You're a paramedic on an oil rig. Your closest backup is 3 > hours away, and that is an airlift which should be reserved for dire > emergencies. A 24 yom comes in complaining of fatigue and general malaise. > > > > > > > > > > > > > > HR 96 > > > > > > > BP 142/90 > > > > > > > RR 12 > > > > > > > O2 99% > > > > > > > > > > > > > > In addition to your normal capabilities, you have some lab > capabilities, IV antibiotics, and some more advanced drugs. However, because > you're alone, you not only need to know what he has, but how to treat him > for at least 3 hours, and whether or not he needs the MedEvac. > > > > > > > > > > > > > > What do you want to know? > > > > > > > > > > > > > > And ie, if you're reading this, thanks for the scenario, > and no you can't answer it! The same goes for anyone who has worked with > me, as I'm sure you've heard this one before. > > > > > > > > > > > > > > > > > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >> Agreed!! Do another one. That was fun! > > > > > > >> > > > > > > >> Christie Hale > > > > > > >> ---- " Sharp wrote: > > > > > > >>> Darn good diagnosis challenge to the group Alyssa. Thanks > for giving us > > > > > > >>> something to scratch our heads about while trying to figure > out what was > > > > > > >>> going on in your patient's head. > > > > > > >>> > > > > > > >>> Barry > > > > > > >>> > > > > > > >>> Barry Sharp, MSHP, MCHES > > > > > > >>> Tobacco Prevention & Control Program Coordinator > > > > > > >>> Substance Abuse Services Unit > > > > > > >>> Mental Health and Substance Abuse Division > > > > > > >>> > > > > > > >>> > > > > > > >>> > > > > > > >>> Re: Mystery Diagnosis > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> No abnormal ammonia levels. > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> Alyssa Woods, NREMT-B > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>> > > > > > > >>>>>>>>>> I'm leaning more to high ammonia level, either due > to a > > > > > > >>> previous > > > > > > >>>>>> viral > > > > > > >>>>>>>>> infection or some congenital defect. > > > > > > >>>>>>>>>> Sent from my iPhone > > > > > > >>>>>>>>>> McGee, EMT-P > > > > > > >>>>>>>>>> > > > > > > >>>>>>>>>> On Jul 13, 2011, at 9:59 AM, Alyssa > > > > > > >>> Woodsamwoods8644@...> > > > > > > >>>>>>>>> wrote: > > > > > > >>>>>>>>>>> No autoimmune, Lupus, Rheumatoid, HIV. > > > > > > >>>>>>>>>>> No infection. > > > > > > >>>>>>>>>>> No leukemia or sickle cell. > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> Alyssa Woods, NREMT-B > > > > > > >>>>>>>>>>> (21) 842-6428 > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>> > > > > > > >>>>>>>>>>>> Leukemia or sickle cell? > > > > > > >>>>>>>>>>>> > > > > > > >>>>>>>>>>>> Excuse any errors. > > > > > > >>>>>>>>>>>> Sent from my iPhone > > > > > > >>>>>>>>>>>> > > > > > > >>>>>>>>>>>> On Jul 12, 2011, at 11:12 PM, Alyssa Woods > > > > > > >>>>>> amwoods8644@...> > > > > > > >>>>>>>>> wrote: > > > > > > >>> > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Australia, yes, he was there 6 mos ago. You're currently in the middle of the ocean and the last time anyone had shore leave was 2 mos ago. No hx, no meds, no allergies, First temp is 99.9 Second is 100.1 His skin is tan, warm, and dry. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > > What is the worker's nationality/country of origin? Has he been there or traveled to, or worked, in any foreign countries recently? > Previous medical history/meds/allergies? > Temp? Skin color and appearance? > > Mark Pavey LP > > Re: Mystery Diagnosis > > > >>>>>>>>>> > > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > > >> closest > > > >>>>> one so far. > > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > and > > > >>>>> focal. > > > >>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>> > > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > > >>>>> swollen lymph node > > > >>>>>>>>>> and one minor abrasion on her chin. > > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > > >>>>> jeremydriver@...> wrote: > > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > > >>>>> bradsattler@...> wrote: > > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > > >>>>> anyway)? > > > >>>>>>>>>>>>> -Brad > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > > >>>>> duration of the > > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > > feel > > > >> any > > > >>>>> other swollen > > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > > is > > > >> the > > > >>>>> node? > > > >>>>>>>>>> Reasesses paying attention for nodules? > > > >>>>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > > >>>>> amwoods8644@...> > > > >>>>>>>>>> wrote: > > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > > >> stop > > > >>>>> her seizures > > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > > >> normal > > > >>>>> treatment > > > >>>>>>>>>> for siezure until you know more. > > > >>>>>>>>>>>>>>> Henry > > > >>>>>>>>>>>>>>> Mystery Diagnosis > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > > in > > > >>>>> the yard, > > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > > her > > > >>>>> parents instantly > > > >>>>>>>>>> calm down and tell you she has no history, no medications, > > and > > > >> no > > > >>>>> known > > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > > >> has > > > >>>>> been going on > > > >>>>>>>>>> for at least 5 minutes. > > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >> ---------------------------------------------------------- > > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> ---------- > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 At this point your Pt grimaces and starts rubbing his leg. You ask him what's wrong and he says it's " Nothing, just a Charlie horse. " Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > > What is the worker's nationality/country of origin? Has he been there or traveled to, or worked, in any foreign countries recently? > Previous medical history/meds/allergies? > Temp? Skin color and appearance? > > Mark Pavey LP > > Re: Mystery Diagnosis > > > >>>>>>>>>> > > > >>>>>>>>>> By which you mean metastatic cancer? No, but you're the > > > >> closest > > > >>>>> one so far. > > > >>>>>>>>>> You're thinking along the right lines -- chronic, medical, > > and > > > >>>>> focal. > > > >>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>> (21) 842-6428 > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>> > > > >>>>>>>>>>> Could be mets ca? Just a thought.. > > > >>>>>>>>>>> > > > >>>>>>>>>>> Excuse any errors. > > > >>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>> > > > >>>>>>>>>>> On Jul 12, 2011, at 1:39 PM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>> No pets. No cat scratches. Pt is pristine except for one > > > >>>>> swollen lymph node > > > >>>>>>>>>> and one minor abrasion on her chin. > > > >>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> Sent from the itty bitty keyboard on my iPhone > > > >>>>>>>>>>>> > > > >>>>>>>>>>>> On Jul 12, 2011, at 13:35, jeremydriver > > > >>>>> jeremydriver@...> wrote: > > > >>>>>>>>>>>>> Cat-scratch encephalopathy? > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 1:28 PM, Brad Sattler > > > >>>>> bradsattler@...> wrote: > > > >>>>>>>>>>>>> Pupils/PMS/Cranial Nerve Responses (those you can check > > > >>>>> anyway)? > > > >>>>>>>>>>>>> -Brad > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>> > > > >>>>>>>>>>>>> On Jul 12, 2011, at 11:22 AM, Alyssa Woods > > > >>>>> amwoods8644@...> wrote: > > > >>>>>>>>>>>>>> High-dose phenobarbital drip calms her seizures for the > > > >>>>> duration of the > > > >>>>>>>>>> drip only, the node is visibly swollen. You don't see or > > feel > > > >> any > > > >>>>> other swollen > > > >>>>>>>>>> lymph nodes. No s/s of anemia. > > > >>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Phenobarbitol drip? Look for s/s of anemia... How big > > is > > > >> the > > > >>>>> node? > > > >>>>>>>>>> Reasesses paying attention for nodules? > > > >>>>>>>>>>>>>>> Sent from my iPhone > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> On Jul 12, 2011, at 1:13 PM, Alyssa Woods > > > >>>>> amwoods8644@...> > > > >>>>>>>>>> wrote: > > > >>>>>>>>>>>>>>> She did not ingest a plant. Benzo's and phenobarbital > > > >> stop > > > >>>>> her seizures > > > >>>>>>>>>> for 30 seconds - 1 minute, paralytics for a few minutes. > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Find out what plant she possibly ingested. Begin your > > > >> normal > > > >>>>> treatment > > > >>>>>>>>>> for siezure until you know more. > > > >>>>>>>>>>>>>>> Henry > > > >>>>>>>>>>>>>>> Mystery Diagnosis > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> You're called out to a 5 year old girl who was playing > > in > > > >>>>> the yard, > > > >>>>>>>>>> when she suddenly had a seizure. When you arrive on scene > > her > > > >>>>> parents instantly > > > >>>>>>>>>> calm down and tell you she has no history, no medications, > > and > > > >> no > > > >>>>> known > > > >>>>>>>>>> allergies. Your patient is having a grand mal seizure which > > > >> has > > > >>>>> been going on > > > >>>>>>>>>> for at least 5 minutes. > > > >>>>>>>>>>>>>>> What's your treatment and what's happening to her? > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> Alyssa Woods, NREMT-B > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> > > > >> ---------------------------------------------------------- > > > >>>>>>>>>>>>>>> No virus found in this incoming message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> ---------- > > > >>>>>>>>>>>>>>> > > > >>>>>>>>>>>>>>> No virus found in this outgoing message. > > > >>>>>>>>>>>>>>> Checked by AVG - www.avg.com > > > >>>>>>>>>>>>>>> Version: 8.5.449 / Virus Database: 271.1.1/3759 - > > Release > > > >>>>> Date: > > > >>>>>>>>>> 07/11/11 18:35:00 > > > >>>>>>>>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Pt denies smoking or drug use. Both are contraband on the vessel; all medications, even OTC, must go through you. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > ok...so how much does the patient smoke? > > and how much Nyquel did he bring on board? > > ck > > > In a message dated 07/14/11 08:21:53 Central Daylight Time, > amwoods8644@... writes: > > CBC: > Hemoglobin-----17 *H > Hematocrit-------52 *H > RBC---------------5.2 > MCV---------------100 > MCH---------------32.7 > MCHC-------------32.7 > Platelets----------276 000 > WBC---------------11 000 *H > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 As I understand it, nowadays OTC meds are banned on most rigs / ships because they don't want injured workers self-treating and failing to notify the medic. There was a big discussion on this practice on one of their listservers recently, because it sometimes unnecessarily ties up / wakes up the medic just to hand out some Tylenol. Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > that is a change. Many of the old off shore workers used to stock up on > Nyquel because booze was banned... > > ck > > > In a message dated 07/14/11 12:35:22 Central Daylight Time, > amwoods8644@... writes: > > Pt denies smoking or drug use. > > Both are contraband on the vessel; all medications, even OTC, must go > through you. > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > > > ok...so how much does the patient smoke? > > > > and how much Nyquel did he bring on board? > > > > ck > > > > > > In a message dated 07/14/11 08:21:53 Central Daylight Time, > > amwoods8644@... writes: > > > > CBC: > > Hemoglobin-----17 *H > > Hematocrit-------52 *H > > RBC---------------5.2 > > MCV---------------100 > > MCH---------------32.7 > > MCHC-------------32.7 > > Platelets----------276 000 > > WBC---------------11 000 *H > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 Is the patient of Sub-Saharan African descent? -Brad Sent from my iPhone > As I understand it, nowadays OTC meds are banned on most rigs / ships because they don't want injured workers self-treating and failing to notify the medic. There was a big discussion on this practice on one of their listservers recently, because it sometimes unnecessarily ties up / wakes up the medic just to hand out some Tylenol. > > Alyssa Woods, NREMT-B > > > Sent from the itty bitty keyboard on my iPhone > > > >> that is a change. Many of the old off shore workers used to stock up on >> Nyquel because booze was banned... >> >> ck >> >> >> In a message dated 07/14/11 12:35:22 Central Daylight Time, >> amwoods8644@... writes: >> >> Pt denies smoking or drug use. >> >> Both are contraband on the vessel; all medications, even OTC, must go >> through you. >> >> Alyssa Woods, NREMT-B >> >> >> Sent from the itty bitty keyboard on my iPhone >> >> >> >>> ok...so how much does the patient smoke? >>> >>> and how much Nyquel did he bring on board? >>> >>> ck >>> >>> >>> In a message dated 07/14/11 08:21:53 Central Daylight Time, >>> amwoods8644@... writes: >>> >>> CBC: >>> Hemoglobin-----17 *H >>> Hematocrit-------52 *H >>> RBC---------------5.2 >>> MCV---------------100 >>> MCH---------------32.7 >>> MCHC-------------32.7 >>> Platelets----------276 000 >>> WBC---------------11 000 *H >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2011 Report Share Posted July 14, 2011 No. Aussie and British before that. Regards, Alyssa Woods, NREMT-B Sent from the itty bitty keyboard on my iPhone > Is the patient of Sub-Saharan African descent? > > -Brad > > Sent from my iPhone > > > > > As I understand it, nowadays OTC meds are banned on most rigs / ships because they don't want injured workers self-treating and failing to notify the medic. There was a big discussion on this practice on one of their listservers recently, because it sometimes unnecessarily ties up / wakes up the medic just to hand out some Tylenol. > > > > Alyssa Woods, NREMT-B > > > > > > Sent from the itty bitty keyboard on my iPhone > > > > > > > >> that is a change. Many of the old off shore workers used to stock up on > >> Nyquel because booze was banned... > >> > >> ck > >> > >> > >> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >> amwoods8644@... writes: > >> > >> Pt denies smoking or drug use. > >> > >> Both are contraband on the vessel; all medications, even OTC, must go > >> through you. > >> > >> Alyssa Woods, NREMT-B > >> > >> > >> Sent from the itty bitty keyboard on my iPhone > >> > >> > >> > >>> ok...so how much does the patient smoke? > >>> > >>> and how much Nyquel did he bring on board? > >>> > >>> ck > >>> > >>> > >>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>> amwoods8644@... writes: > >>> > >>> CBC: > >>> Hemoglobin-----17 *H > >>> Hematocrit-------52 *H > >>> RBC---------------5.2 > >>> MCV---------------100 > >>> MCH---------------32.7 > >>> MCHC-------------32.7 > >>> Platelets----------276 000 > >>> WBC---------------11 000 *H > >>> > >>> Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.