Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Dehydration? 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 about the hypothalamus? And Mr Sharp - no dehydration. Alyssa Woods, NREMT-B > Hypothalamus? > > Wes > > On the move from my iPhone > > > > > Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > > > > You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > > > > > > Let's review our hints. > > > > It's not external, it's internal. > > The temperature is important. > > It's an act of God that man can fix. > > It's chronic, and focal. > > We create something kind of similar in dialysis patients; in her we must undo it. > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > >> Do we have two different things going on here? Perhaps the seizure is > >> related to an underlying issue in her skull that was set off by the > >> relatively minor injury that caused the scrape on the chin and an > >> undiagnosed oncology issue that is related to the lymph node. > >> > >> If not, then my guess is that it was Col. Mustard in the drawing room > >> with the monkey wrench. > >> > >> Great mystery diagnosis....it's been fun watching the discussions and > >> thought processes going on. > >> > >> Barry > >> > >> Barry Sharp, MSHP, MCHES > >> > >> Tobacco Prevention & Control Program Coordinator > >> > >> Substance Abuse Services Unit > >> > >> Mental Health and Substance Abuse Division > >> > >> > >> > >> ________________________________ > >> > >> From: texasems-l [mailto:texasems-l ] On > >> Behalf Of Henry Barber > >> Sent: Wednesday, July 13, 2011 7:09 AM > >> To: texasems-l > >> Subject: Re: Mystery Diagnosis > >> > >> I think she was bitten by a bat while removing a tic. This has been a > >> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > >> an easy one " and give us the answer. > >> > >> Henry > >> Re: Mystery Diagnosis > >> > >> OK, let's see if I can sum up the current findings of the last 40 odd > >> messages. My comments are in line at >: > >> > >> Chief Complaint: New Onset Seizure > >> > >> History of Present Illness: 5 yo WF previously in good health, noted to > >> have major convulsions after playing outside on a hot afternoon. Onset > >> is un > >> certain as the parents were unpacking from the recent move. The > >> convulsions > >> continued for at least 5 minutes, and recurred after appropriate initial > >> > >> treatment. > >> > >> Past History: no medical or surgical history, no allergies, no > >> medications. > >> > >> Social history is positive for a pregnant mother who is slightly > >> overdue, > >> Just moved into a new house with a koi pond, but no plants besides > >> grass, > >> and no known history of chemical usage in the hard or pond > >> > >>> Is there anything interesting in the Family History > >> > >> Review of Systems: The node noted on the physical exam has been present > >> for a week, and child has an appointment with her (? new) pediatrician > >> already scheduled. > >> > >> Physical exam is positive for > >> > >> VS: Hypothermic at 95 F Rectal, o2: 90% room air > >> RR: 8, very shallow and erratic, no gag reflex > >> HR: 158, sinus arrhythmia, strong pulse > >> BP: 98/56 > >> > >> Mental status: she is not responsive enough to answer questions or > >> follow > >> commands. Reaction to pain before RSI is NOT noted. > >> > >> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > >> mucosa is NOT pale. Gag Reflex is absent > >> > >>> What would be the effective Glasgow Coma Score of this patient? > >> > >> Neck: no nodes or obvious nuchal rigidity > >> > >> Chest and Abdomen findings are NOT reported. > >> > >> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > >> NOT > >> a buboe. > >> > >> Skin: aside from the abrasion, there are no rashes or bruising noted. No > >> > >> evidence of arachnid bites or stings are noted. > >> > >> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > >> reported. > >> > >> Working evaluation: Obtunded patient with ongoing seizures and > >> ventilatory > >> compromise, significant hypothermia. > >> > >> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > >> given, and the seizures stop for less than one minute before tremors > >> which > >> progress to grand mal activity start. Core Body temp does NOT respond to > >> > >> environmental temperature and aggressive warming > >> > >>> note: WHY are you hanging around to try to warm this patient? > >> > >> Repeat VS: > >> o2: 96% on 15 LPM NRB > >> RR: 6, very shallow and erratic, no gag reflex > >> HR: 164, sinus arrhythmia, strong pulse > >> BP: 94/52 > >> > >>> At this point, more aggressive ventilatory support should be started. > >> Question for the group: > >> a: name *at least* two reasons for the decrease in ventilatory effort? > >> b: name *at least* two methods for supporting ventilation? > >> > >> Further Treatment: The patient is set up for RSI- the seizures stop for > >> 'a > >> few minutes' under the influence of the paralytics. Phenobarbital is > >> loaded, but is no more effective than Benzos at terminating the > >> seizures, as > >> they reported restart shortly after the loading drip is complete. > >> > >>> note: this is VERY unusual for seizures. question for the group: What > >> is > >> the next step in the treatment of the seizures *besides* transport. > >> > >> Active methods to support ventilation is NOT specified. > >> > >> Transport issues: You have one ER without so much as a dedicated > >> pediatrician which is about 5-10 min northwest, and one which is a > >> dedicated > >> children's hospital 30-40 minutes in the opposite direction. The two > >> closest > >> flight teams are out on other calls, and consequently their ETA is worse > >> than > >> yours. > >> > >>> incidentally, this is a case where the patient needs a good EM doc, NOT > >> > >> your run of the mill pediatrician! > >> > >> I agree, there is significant internal derangement of this patient. As > >> Ms. > >> Wood has already noted that the diagnosis was difficult even in the ED, > >> I > >> doubt anyone will guess correctly at this point. > >> > >> What is next? > >> > >> ck > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 What about the hypothalamus? And Mr Sharp - no dehydration. Alyssa Woods, NREMT-B > Hypothalamus? > > Wes > > On the move from my iPhone > > > > > Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > > > > You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > > > > > > Let's review our hints. > > > > It's not external, it's internal. > > The temperature is important. > > It's an act of God that man can fix. > > It's chronic, and focal. > > We create something kind of similar in dialysis patients; in her we must undo it. > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > >> Do we have two different things going on here? Perhaps the seizure is > >> related to an underlying issue in her skull that was set off by the > >> relatively minor injury that caused the scrape on the chin and an > >> undiagnosed oncology issue that is related to the lymph node. > >> > >> If not, then my guess is that it was Col. Mustard in the drawing room > >> with the monkey wrench. > >> > >> Great mystery diagnosis....it's been fun watching the discussions and > >> thought processes going on. > >> > >> Barry > >> > >> Barry Sharp, MSHP, MCHES > >> > >> Tobacco Prevention & Control Program Coordinator > >> > >> Substance Abuse Services Unit > >> > >> Mental Health and Substance Abuse Division > >> > >> > >> > >> ________________________________ > >> > >> From: texasems-l [mailto:texasems-l ] On > >> Behalf Of Henry Barber > >> Sent: Wednesday, July 13, 2011 7:09 AM > >> To: texasems-l > >> Subject: Re: Mystery Diagnosis > >> > >> I think she was bitten by a bat while removing a tic. This has been a > >> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > >> an easy one " and give us the answer. > >> > >> Henry > >> Re: Mystery Diagnosis > >> > >> OK, let's see if I can sum up the current findings of the last 40 odd > >> messages. My comments are in line at >: > >> > >> Chief Complaint: New Onset Seizure > >> > >> History of Present Illness: 5 yo WF previously in good health, noted to > >> have major convulsions after playing outside on a hot afternoon. Onset > >> is un > >> certain as the parents were unpacking from the recent move. The > >> convulsions > >> continued for at least 5 minutes, and recurred after appropriate initial > >> > >> treatment. > >> > >> Past History: no medical or surgical history, no allergies, no > >> medications. > >> > >> Social history is positive for a pregnant mother who is slightly > >> overdue, > >> Just moved into a new house with a koi pond, but no plants besides > >> grass, > >> and no known history of chemical usage in the hard or pond > >> > >>> Is there anything interesting in the Family History > >> > >> Review of Systems: The node noted on the physical exam has been present > >> for a week, and child has an appointment with her (? new) pediatrician > >> already scheduled. > >> > >> Physical exam is positive for > >> > >> VS: Hypothermic at 95 F Rectal, o2: 90% room air > >> RR: 8, very shallow and erratic, no gag reflex > >> HR: 158, sinus arrhythmia, strong pulse > >> BP: 98/56 > >> > >> Mental status: she is not responsive enough to answer questions or > >> follow > >> commands. Reaction to pain before RSI is NOT noted. > >> > >> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > >> mucosa is NOT pale. Gag Reflex is absent > >> > >>> What would be the effective Glasgow Coma Score of this patient? > >> > >> Neck: no nodes or obvious nuchal rigidity > >> > >> Chest and Abdomen findings are NOT reported. > >> > >> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > >> NOT > >> a buboe. > >> > >> Skin: aside from the abrasion, there are no rashes or bruising noted. No > >> > >> evidence of arachnid bites or stings are noted. > >> > >> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > >> reported. > >> > >> Working evaluation: Obtunded patient with ongoing seizures and > >> ventilatory > >> compromise, significant hypothermia. > >> > >> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > >> given, and the seizures stop for less than one minute before tremors > >> which > >> progress to grand mal activity start. Core Body temp does NOT respond to > >> > >> environmental temperature and aggressive warming > >> > >>> note: WHY are you hanging around to try to warm this patient? > >> > >> Repeat VS: > >> o2: 96% on 15 LPM NRB > >> RR: 6, very shallow and erratic, no gag reflex > >> HR: 164, sinus arrhythmia, strong pulse > >> BP: 94/52 > >> > >>> At this point, more aggressive ventilatory support should be started. > >> Question for the group: > >> a: name *at least* two reasons for the decrease in ventilatory effort? > >> b: name *at least* two methods for supporting ventilation? > >> > >> Further Treatment: The patient is set up for RSI- the seizures stop for > >> 'a > >> few minutes' under the influence of the paralytics. Phenobarbital is > >> loaded, but is no more effective than Benzos at terminating the > >> seizures, as > >> they reported restart shortly after the loading drip is complete. > >> > >>> note: this is VERY unusual for seizures. question for the group: What > >> is > >> the next step in the treatment of the seizures *besides* transport. > >> > >> Active methods to support ventilation is NOT specified. > >> > >> Transport issues: You have one ER without so much as a dedicated > >> pediatrician which is about 5-10 min northwest, and one which is a > >> dedicated > >> children's hospital 30-40 minutes in the opposite direction. The two > >> closest > >> flight teams are out on other calls, and consequently their ETA is worse > >> than > >> yours. > >> > >>> incidentally, this is a case where the patient needs a good EM doc, NOT > >> > >> your run of the mill pediatrician! > >> > >> I agree, there is significant internal derangement of this patient. As > >> Ms. > >> Wood has already noted that the diagnosis was difficult even in the ED, > >> I > >> doubt anyone will guess correctly at this point. > >> > >> What is next? > >> > >> ck > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Hypothalamic epilepsy is coming to mind. Wes On the move from my iPhone > What about the hypothalamus? > > And Mr Sharp - no dehydration. > > > > Alyssa Woods, NREMT-B > > > > > >> Hypothalamus? >> >> Wes >> >> On the move from my iPhone >> >> >> >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. >>> >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. >>> >>> >>> Let's review our hints. >>> >>> It's not external, it's internal. >>> The temperature is important. >>> It's an act of God that man can fix. >>> It's chronic, and focal. >>> We create something kind of similar in dialysis patients; in her we must undo it. >>> >>> >>> Alyssa Woods, NREMT-B >>> >>> >>> >>> >>> >>> >>>> Do we have two different things going on here? Perhaps the seizure is >>>> related to an underlying issue in her skull that was set off by the >>>> relatively minor injury that caused the scrape on the chin and an >>>> undiagnosed oncology issue that is related to the lymph node. >>>> >>>> If not, then my guess is that it was Col. Mustard in the drawing room >>>> with the monkey wrench. >>>> >>>> Great mystery diagnosis....it's been fun watching the discussions and >>>> thought processes going on. >>>> >>>> Barry >>>> >>>> Barry Sharp, MSHP, MCHES >>>> >>>> Tobacco Prevention & Control Program Coordinator >>>> >>>> Substance Abuse Services Unit >>>> >>>> Mental Health and Substance Abuse Division >>>> >>>> >>>> >>>> ________________________________ >>>> >>>> From: texasems-l [mailto:texasems-l ] On >>>> Behalf Of Henry Barber >>>> Sent: Wednesday, July 13, 2011 7:09 AM >>>> To: texasems-l >>>> Subject: Re: Mystery Diagnosis >>>> >>>> I think she was bitten by a bat while removing a tic. This has been a >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats >>>> an easy one " and give us the answer. >>>> >>>> Henry >>>> Re: Mystery Diagnosis >>>> >>>> OK, let's see if I can sum up the current findings of the last 40 odd >>>> messages. My comments are in line at >: >>>> >>>> Chief Complaint: New Onset Seizure >>>> >>>> History of Present Illness: 5 yo WF previously in good health, noted to >>>> have major convulsions after playing outside on a hot afternoon. Onset >>>> is un >>>> certain as the parents were unpacking from the recent move. The >>>> convulsions >>>> continued for at least 5 minutes, and recurred after appropriate initial >>>> >>>> treatment. >>>> >>>> Past History: no medical or surgical history, no allergies, no >>>> medications. >>>> >>>> Social history is positive for a pregnant mother who is slightly >>>> overdue, >>>> Just moved into a new house with a koi pond, but no plants besides >>>> grass, >>>> and no known history of chemical usage in the hard or pond >>>> >>>>> Is there anything interesting in the Family History >>>> >>>> Review of Systems: The node noted on the physical exam has been present >>>> for a week, and child has an appointment with her (? new) pediatrician >>>> already scheduled. >>>> >>>> Physical exam is positive for >>>> >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air >>>> RR: 8, very shallow and erratic, no gag reflex >>>> HR: 158, sinus arrhythmia, strong pulse >>>> BP: 98/56 >>>> >>>> Mental status: she is not responsive enough to answer questions or >>>> follow >>>> commands. Reaction to pain before RSI is NOT noted. >>>> >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. >>>> mucosa is NOT pale. Gag Reflex is absent >>>> >>>>> What would be the effective Glasgow Coma Score of this patient? >>>> >>>> Neck: no nodes or obvious nuchal rigidity >>>> >>>> Chest and Abdomen findings are NOT reported. >>>> >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is >>>> NOT >>>> a buboe. >>>> >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No >>>> >>>> evidence of arachnid bites or stings are noted. >>>> >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT >>>> reported. >>>> >>>> Working evaluation: Obtunded patient with ongoing seizures and >>>> ventilatory >>>> compromise, significant hypothermia. >>>> >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is >>>> given, and the seizures stop for less than one minute before tremors >>>> which >>>> progress to grand mal activity start. Core Body temp does NOT respond to >>>> >>>> environmental temperature and aggressive warming >>>> >>>>> note: WHY are you hanging around to try to warm this patient? >>>> >>>> Repeat VS: >>>> o2: 96% on 15 LPM NRB >>>> RR: 6, very shallow and erratic, no gag reflex >>>> HR: 164, sinus arrhythmia, strong pulse >>>> BP: 94/52 >>>> >>>>> At this point, more aggressive ventilatory support should be started. >>>> Question for the group: >>>> a: name *at least* two reasons for the decrease in ventilatory effort? >>>> b: name *at least* two methods for supporting ventilation? >>>> >>>> Further Treatment: The patient is set up for RSI- the seizures stop for >>>> 'a >>>> few minutes' under the influence of the paralytics. Phenobarbital is >>>> loaded, but is no more effective than Benzos at terminating the >>>> seizures, as >>>> they reported restart shortly after the loading drip is complete. >>>> >>>>> note: this is VERY unusual for seizures. question for the group: What >>>> is >>>> the next step in the treatment of the seizures *besides* transport. >>>> >>>> Active methods to support ventilation is NOT specified. >>>> >>>> Transport issues: You have one ER without so much as a dedicated >>>> pediatrician which is about 5-10 min northwest, and one which is a >>>> dedicated >>>> children's hospital 30-40 minutes in the opposite direction. The two >>>> closest >>>> flight teams are out on other calls, and consequently their ETA is worse >>>> than >>>> yours. >>>> >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT >>>> >>>> your run of the mill pediatrician! >>>> >>>> I agree, there is significant internal derangement of this patient. As >>>> Ms. >>>> Wood has already noted that the diagnosis was difficult even in the ED, >>>> I >>>> doubt anyone will guess correctly at this point. >>>> >>>> What is next? >>>> >>>> ck >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Hypothalamic epilepsy is coming to mind. Wes On the move from my iPhone > What about the hypothalamus? > > And Mr Sharp - no dehydration. > > > > Alyssa Woods, NREMT-B > > > > > >> Hypothalamus? >> >> Wes >> >> On the move from my iPhone >> >> >> >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. >>> >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. >>> >>> >>> Let's review our hints. >>> >>> It's not external, it's internal. >>> The temperature is important. >>> It's an act of God that man can fix. >>> It's chronic, and focal. >>> We create something kind of similar in dialysis patients; in her we must undo it. >>> >>> >>> Alyssa Woods, NREMT-B >>> >>> >>> >>> >>> >>> >>>> Do we have two different things going on here? Perhaps the seizure is >>>> related to an underlying issue in her skull that was set off by the >>>> relatively minor injury that caused the scrape on the chin and an >>>> undiagnosed oncology issue that is related to the lymph node. >>>> >>>> If not, then my guess is that it was Col. Mustard in the drawing room >>>> with the monkey wrench. >>>> >>>> Great mystery diagnosis....it's been fun watching the discussions and >>>> thought processes going on. >>>> >>>> Barry >>>> >>>> Barry Sharp, MSHP, MCHES >>>> >>>> Tobacco Prevention & Control Program Coordinator >>>> >>>> Substance Abuse Services Unit >>>> >>>> Mental Health and Substance Abuse Division >>>> >>>> >>>> >>>> ________________________________ >>>> >>>> From: texasems-l [mailto:texasems-l ] On >>>> Behalf Of Henry Barber >>>> Sent: Wednesday, July 13, 2011 7:09 AM >>>> To: texasems-l >>>> Subject: Re: Mystery Diagnosis >>>> >>>> I think she was bitten by a bat while removing a tic. This has been a >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats >>>> an easy one " and give us the answer. >>>> >>>> Henry >>>> Re: Mystery Diagnosis >>>> >>>> OK, let's see if I can sum up the current findings of the last 40 odd >>>> messages. My comments are in line at >: >>>> >>>> Chief Complaint: New Onset Seizure >>>> >>>> History of Present Illness: 5 yo WF previously in good health, noted to >>>> have major convulsions after playing outside on a hot afternoon. Onset >>>> is un >>>> certain as the parents were unpacking from the recent move. The >>>> convulsions >>>> continued for at least 5 minutes, and recurred after appropriate initial >>>> >>>> treatment. >>>> >>>> Past History: no medical or surgical history, no allergies, no >>>> medications. >>>> >>>> Social history is positive for a pregnant mother who is slightly >>>> overdue, >>>> Just moved into a new house with a koi pond, but no plants besides >>>> grass, >>>> and no known history of chemical usage in the hard or pond >>>> >>>>> Is there anything interesting in the Family History >>>> >>>> Review of Systems: The node noted on the physical exam has been present >>>> for a week, and child has an appointment with her (? new) pediatrician >>>> already scheduled. >>>> >>>> Physical exam is positive for >>>> >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air >>>> RR: 8, very shallow and erratic, no gag reflex >>>> HR: 158, sinus arrhythmia, strong pulse >>>> BP: 98/56 >>>> >>>> Mental status: she is not responsive enough to answer questions or >>>> follow >>>> commands. Reaction to pain before RSI is NOT noted. >>>> >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. >>>> mucosa is NOT pale. Gag Reflex is absent >>>> >>>>> What would be the effective Glasgow Coma Score of this patient? >>>> >>>> Neck: no nodes or obvious nuchal rigidity >>>> >>>> Chest and Abdomen findings are NOT reported. >>>> >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is >>>> NOT >>>> a buboe. >>>> >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No >>>> >>>> evidence of arachnid bites or stings are noted. >>>> >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT >>>> reported. >>>> >>>> Working evaluation: Obtunded patient with ongoing seizures and >>>> ventilatory >>>> compromise, significant hypothermia. >>>> >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is >>>> given, and the seizures stop for less than one minute before tremors >>>> which >>>> progress to grand mal activity start. Core Body temp does NOT respond to >>>> >>>> environmental temperature and aggressive warming >>>> >>>>> note: WHY are you hanging around to try to warm this patient? >>>> >>>> Repeat VS: >>>> o2: 96% on 15 LPM NRB >>>> RR: 6, very shallow and erratic, no gag reflex >>>> HR: 164, sinus arrhythmia, strong pulse >>>> BP: 94/52 >>>> >>>>> At this point, more aggressive ventilatory support should be started. >>>> Question for the group: >>>> a: name *at least* two reasons for the decrease in ventilatory effort? >>>> b: name *at least* two methods for supporting ventilation? >>>> >>>> Further Treatment: The patient is set up for RSI- the seizures stop for >>>> 'a >>>> few minutes' under the influence of the paralytics. Phenobarbital is >>>> loaded, but is no more effective than Benzos at terminating the >>>> seizures, as >>>> they reported restart shortly after the loading drip is complete. >>>> >>>>> note: this is VERY unusual for seizures. question for the group: What >>>> is >>>> the next step in the treatment of the seizures *besides* transport. >>>> >>>> Active methods to support ventilation is NOT specified. >>>> >>>> Transport issues: You have one ER without so much as a dedicated >>>> pediatrician which is about 5-10 min northwest, and one which is a >>>> dedicated >>>> children's hospital 30-40 minutes in the opposite direction. The two >>>> closest >>>> flight teams are out on other calls, and consequently their ETA is worse >>>> than >>>> yours. >>>> >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT >>>> >>>> your run of the mill pediatrician! >>>> >>>> I agree, there is significant internal derangement of this patient. As >>>> Ms. >>>> Wood has already noted that the diagnosis was difficult even in the ED, >>>> I >>>> doubt anyone will guess correctly at this point. >>>> >>>> What is next? >>>> >>>> ck >>>> >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Belay that last. Hypothalamic hamartoma. Wes On the move from my iPhone > Hypothalamic epilepsy is coming to mind. > > Wes > > On the move from my iPhone > > > > > What about the hypothalamus? > > > > And Mr Sharp - no dehydration. > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > >> Hypothalamus? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > >>> > >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > >>> > >>> > >>> Let's review our hints. > >>> > >>> It's not external, it's internal. > >>> The temperature is important. > >>> It's an act of God that man can fix. > >>> It's chronic, and focal. > >>> We create something kind of similar in dialysis patients; in her we must undo it. > >>> > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Do we have two different things going on here? Perhaps the seizure is > >>>> related to an underlying issue in her skull that was set off by the > >>>> relatively minor injury that caused the scrape on the chin and an > >>>> undiagnosed oncology issue that is related to the lymph node. > >>>> > >>>> If not, then my guess is that it was Col. Mustard in the drawing room > >>>> with the monkey wrench. > >>>> > >>>> Great mystery diagnosis....it's been fun watching the discussions and > >>>> thought processes going on. > >>>> > >>>> Barry > >>>> > >>>> Barry Sharp, MSHP, MCHES > >>>> > >>>> Tobacco Prevention & Control Program Coordinator > >>>> > >>>> Substance Abuse Services Unit > >>>> > >>>> Mental Health and Substance Abuse Division > >>>> > >>>> > >>>> > >>>> ________________________________ > >>>> > >>>> From: texasems-l [mailto:texasems-l ] On > >>>> Behalf Of Henry Barber > >>>> Sent: Wednesday, July 13, 2011 7:09 AM > >>>> To: texasems-l > >>>> Subject: Re: Mystery Diagnosis > >>>> > >>>> I think she was bitten by a bat while removing a tic. This has been a > >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > >>>> an easy one " and give us the answer. > >>>> > >>>> Henry > >>>> Re: Mystery Diagnosis > >>>> > >>>> OK, let's see if I can sum up the current findings of the last 40 odd > >>>> messages. My comments are in line at >: > >>>> > >>>> Chief Complaint: New Onset Seizure > >>>> > >>>> History of Present Illness: 5 yo WF previously in good health, noted to > >>>> have major convulsions after playing outside on a hot afternoon. Onset > >>>> is un > >>>> certain as the parents were unpacking from the recent move. The > >>>> convulsions > >>>> continued for at least 5 minutes, and recurred after appropriate initial > >>>> > >>>> treatment. > >>>> > >>>> Past History: no medical or surgical history, no allergies, no > >>>> medications. > >>>> > >>>> Social history is positive for a pregnant mother who is slightly > >>>> overdue, > >>>> Just moved into a new house with a koi pond, but no plants besides > >>>> grass, > >>>> and no known history of chemical usage in the hard or pond > >>>> > >>>>> Is there anything interesting in the Family History > >>>> > >>>> Review of Systems: The node noted on the physical exam has been present > >>>> for a week, and child has an appointment with her (? new) pediatrician > >>>> already scheduled. > >>>> > >>>> Physical exam is positive for > >>>> > >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air > >>>> RR: 8, very shallow and erratic, no gag reflex > >>>> HR: 158, sinus arrhythmia, strong pulse > >>>> BP: 98/56 > >>>> > >>>> Mental status: she is not responsive enough to answer questions or > >>>> follow > >>>> commands. Reaction to pain before RSI is NOT noted. > >>>> > >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > >>>> mucosa is NOT pale. Gag Reflex is absent > >>>> > >>>>> What would be the effective Glasgow Coma Score of this patient? > >>>> > >>>> Neck: no nodes or obvious nuchal rigidity > >>>> > >>>> Chest and Abdomen findings are NOT reported. > >>>> > >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > >>>> NOT > >>>> a buboe. > >>>> > >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No > >>>> > >>>> evidence of arachnid bites or stings are noted. > >>>> > >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > >>>> reported. > >>>> > >>>> Working evaluation: Obtunded patient with ongoing seizures and > >>>> ventilatory > >>>> compromise, significant hypothermia. > >>>> > >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > >>>> given, and the seizures stop for less than one minute before tremors > >>>> which > >>>> progress to grand mal activity start. Core Body temp does NOT respond to > >>>> > >>>> environmental temperature and aggressive warming > >>>> > >>>>> note: WHY are you hanging around to try to warm this patient? > >>>> > >>>> Repeat VS: > >>>> o2: 96% on 15 LPM NRB > >>>> RR: 6, very shallow and erratic, no gag reflex > >>>> HR: 164, sinus arrhythmia, strong pulse > >>>> BP: 94/52 > >>>> > >>>>> At this point, more aggressive ventilatory support should be started. > >>>> Question for the group: > >>>> a: name *at least* two reasons for the decrease in ventilatory effort? > >>>> b: name *at least* two methods for supporting ventilation? > >>>> > >>>> Further Treatment: The patient is set up for RSI- the seizures stop for > >>>> 'a > >>>> few minutes' under the influence of the paralytics. Phenobarbital is > >>>> loaded, but is no more effective than Benzos at terminating the > >>>> seizures, as > >>>> they reported restart shortly after the loading drip is complete. > >>>> > >>>>> note: this is VERY unusual for seizures. question for the group: What > >>>> is > >>>> the next step in the treatment of the seizures *besides* transport. > >>>> > >>>> Active methods to support ventilation is NOT specified. > >>>> > >>>> Transport issues: You have one ER without so much as a dedicated > >>>> pediatrician which is about 5-10 min northwest, and one which is a > >>>> dedicated > >>>> children's hospital 30-40 minutes in the opposite direction. The two > >>>> closest > >>>> flight teams are out on other calls, and consequently their ETA is worse > >>>> than > >>>> yours. > >>>> > >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT > >>>> > >>>> your run of the mill pediatrician! > >>>> > >>>> I agree, there is significant internal derangement of this patient. As > >>>> Ms. > >>>> Wood has already noted that the diagnosis was difficult even in the ED, > >>>> I > >>>> doubt anyone will guess correctly at this point. > >>>> > >>>> What is next? > >>>> > >>>> ck > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 It's not epilepsy, hypothalamic or otherwise. Though I'm surprised that (if I'm not mistaken) no one guessed new-onset epilepsy till now. Alyssa Woods, NREMT-B > Hypothalamic epilepsy is coming to mind. > > Wes > > On the move from my iPhone > > > > > What about the hypothalamus? > > > > And Mr Sharp - no dehydration. > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > >> Hypothalamus? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > >>> > >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > >>> > >>> > >>> Let's review our hints. > >>> > >>> It's not external, it's internal. > >>> The temperature is important. > >>> It's an act of God that man can fix. > >>> It's chronic, and focal. > >>> We create something kind of similar in dialysis patients; in her we must undo it. > >>> > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Do we have two different things going on here? Perhaps the seizure is > >>>> related to an underlying issue in her skull that was set off by the > >>>> relatively minor injury that caused the scrape on the chin and an > >>>> undiagnosed oncology issue that is related to the lymph node. > >>>> > >>>> If not, then my guess is that it was Col. Mustard in the drawing room > >>>> with the monkey wrench. > >>>> > >>>> Great mystery diagnosis....it's been fun watching the discussions and > >>>> thought processes going on. > >>>> > >>>> Barry > >>>> > >>>> Barry Sharp, MSHP, MCHES > >>>> > >>>> Tobacco Prevention & Control Program Coordinator > >>>> > >>>> Substance Abuse Services Unit > >>>> > >>>> Mental Health and Substance Abuse Division > >>>> > >>>> > >>>> > >>>> ________________________________ > >>>> > >>>> From: texasems-l [mailto:texasems-l ] On > >>>> Behalf Of Henry Barber > >>>> Sent: Wednesday, July 13, 2011 7:09 AM > >>>> To: texasems-l > >>>> Subject: Re: Mystery Diagnosis > >>>> > >>>> I think she was bitten by a bat while removing a tic. This has been a > >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > >>>> an easy one " and give us the answer. > >>>> > >>>> Henry > >>>> Re: Mystery Diagnosis > >>>> > >>>> OK, let's see if I can sum up the current findings of the last 40 odd > >>>> messages. My comments are in line at >: > >>>> > >>>> Chief Complaint: New Onset Seizure > >>>> > >>>> History of Present Illness: 5 yo WF previously in good health, noted to > >>>> have major convulsions after playing outside on a hot afternoon. Onset > >>>> is un > >>>> certain as the parents were unpacking from the recent move. The > >>>> convulsions > >>>> continued for at least 5 minutes, and recurred after appropriate initial > >>>> > >>>> treatment. > >>>> > >>>> Past History: no medical or surgical history, no allergies, no > >>>> medications. > >>>> > >>>> Social history is positive for a pregnant mother who is slightly > >>>> overdue, > >>>> Just moved into a new house with a koi pond, but no plants besides > >>>> grass, > >>>> and no known history of chemical usage in the hard or pond > >>>> > >>>>> Is there anything interesting in the Family History > >>>> > >>>> Review of Systems: The node noted on the physical exam has been present > >>>> for a week, and child has an appointment with her (? new) pediatrician > >>>> already scheduled. > >>>> > >>>> Physical exam is positive for > >>>> > >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air > >>>> RR: 8, very shallow and erratic, no gag reflex > >>>> HR: 158, sinus arrhythmia, strong pulse > >>>> BP: 98/56 > >>>> > >>>> Mental status: she is not responsive enough to answer questions or > >>>> follow > >>>> commands. Reaction to pain before RSI is NOT noted. > >>>> > >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > >>>> mucosa is NOT pale. Gag Reflex is absent > >>>> > >>>>> What would be the effective Glasgow Coma Score of this patient? > >>>> > >>>> Neck: no nodes or obvious nuchal rigidity > >>>> > >>>> Chest and Abdomen findings are NOT reported. > >>>> > >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > >>>> NOT > >>>> a buboe. > >>>> > >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No > >>>> > >>>> evidence of arachnid bites or stings are noted. > >>>> > >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > >>>> reported. > >>>> > >>>> Working evaluation: Obtunded patient with ongoing seizures and > >>>> ventilatory > >>>> compromise, significant hypothermia. > >>>> > >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > >>>> given, and the seizures stop for less than one minute before tremors > >>>> which > >>>> progress to grand mal activity start. Core Body temp does NOT respond to > >>>> > >>>> environmental temperature and aggressive warming > >>>> > >>>>> note: WHY are you hanging around to try to warm this patient? > >>>> > >>>> Repeat VS: > >>>> o2: 96% on 15 LPM NRB > >>>> RR: 6, very shallow and erratic, no gag reflex > >>>> HR: 164, sinus arrhythmia, strong pulse > >>>> BP: 94/52 > >>>> > >>>>> At this point, more aggressive ventilatory support should be started. > >>>> Question for the group: > >>>> a: name *at least* two reasons for the decrease in ventilatory effort? > >>>> b: name *at least* two methods for supporting ventilation? > >>>> > >>>> Further Treatment: The patient is set up for RSI- the seizures stop for > >>>> 'a > >>>> few minutes' under the influence of the paralytics. Phenobarbital is > >>>> loaded, but is no more effective than Benzos at terminating the > >>>> seizures, as > >>>> they reported restart shortly after the loading drip is complete. > >>>> > >>>>> note: this is VERY unusual for seizures. question for the group: What > >>>> is > >>>> the next step in the treatment of the seizures *besides* transport. > >>>> > >>>> Active methods to support ventilation is NOT specified. > >>>> > >>>> Transport issues: You have one ER without so much as a dedicated > >>>> pediatrician which is about 5-10 min northwest, and one which is a > >>>> dedicated > >>>> children's hospital 30-40 minutes in the opposite direction. The two > >>>> closest > >>>> flight teams are out on other calls, and consequently their ETA is worse > >>>> than > >>>> yours. > >>>> > >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT > >>>> > >>>> your run of the mill pediatrician! > >>>> > >>>> I agree, there is significant internal derangement of this patient. As > >>>> Ms. > >>>> Wood has already noted that the diagnosis was difficult even in the ED, > >>>> I > >>>> doubt anyone will guess correctly at this point. > >>>> > >>>> What is next? > >>>> > >>>> ck > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 It's not epilepsy, hypothalamic or otherwise. Though I'm surprised that (if I'm not mistaken) no one guessed new-onset epilepsy till now. Alyssa Woods, NREMT-B > Hypothalamic epilepsy is coming to mind. > > Wes > > On the move from my iPhone > > > > > What about the hypothalamus? > > > > And Mr Sharp - no dehydration. > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > >> Hypothalamus? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > >>> > >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > >>> > >>> > >>> Let's review our hints. > >>> > >>> It's not external, it's internal. > >>> The temperature is important. > >>> It's an act of God that man can fix. > >>> It's chronic, and focal. > >>> We create something kind of similar in dialysis patients; in her we must undo it. > >>> > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> > >>> > >>> > >>> > >>>> Do we have two different things going on here? Perhaps the seizure is > >>>> related to an underlying issue in her skull that was set off by the > >>>> relatively minor injury that caused the scrape on the chin and an > >>>> undiagnosed oncology issue that is related to the lymph node. > >>>> > >>>> If not, then my guess is that it was Col. Mustard in the drawing room > >>>> with the monkey wrench. > >>>> > >>>> Great mystery diagnosis....it's been fun watching the discussions and > >>>> thought processes going on. > >>>> > >>>> Barry > >>>> > >>>> Barry Sharp, MSHP, MCHES > >>>> > >>>> Tobacco Prevention & Control Program Coordinator > >>>> > >>>> Substance Abuse Services Unit > >>>> > >>>> Mental Health and Substance Abuse Division > >>>> > >>>> > >>>> > >>>> ________________________________ > >>>> > >>>> From: texasems-l [mailto:texasems-l ] On > >>>> Behalf Of Henry Barber > >>>> Sent: Wednesday, July 13, 2011 7:09 AM > >>>> To: texasems-l > >>>> Subject: Re: Mystery Diagnosis > >>>> > >>>> I think she was bitten by a bat while removing a tic. This has been a > >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > >>>> an easy one " and give us the answer. > >>>> > >>>> Henry > >>>> Re: Mystery Diagnosis > >>>> > >>>> OK, let's see if I can sum up the current findings of the last 40 odd > >>>> messages. My comments are in line at >: > >>>> > >>>> Chief Complaint: New Onset Seizure > >>>> > >>>> History of Present Illness: 5 yo WF previously in good health, noted to > >>>> have major convulsions after playing outside on a hot afternoon. Onset > >>>> is un > >>>> certain as the parents were unpacking from the recent move. The > >>>> convulsions > >>>> continued for at least 5 minutes, and recurred after appropriate initial > >>>> > >>>> treatment. > >>>> > >>>> Past History: no medical or surgical history, no allergies, no > >>>> medications. > >>>> > >>>> Social history is positive for a pregnant mother who is slightly > >>>> overdue, > >>>> Just moved into a new house with a koi pond, but no plants besides > >>>> grass, > >>>> and no known history of chemical usage in the hard or pond > >>>> > >>>>> Is there anything interesting in the Family History > >>>> > >>>> Review of Systems: The node noted on the physical exam has been present > >>>> for a week, and child has an appointment with her (? new) pediatrician > >>>> already scheduled. > >>>> > >>>> Physical exam is positive for > >>>> > >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air > >>>> RR: 8, very shallow and erratic, no gag reflex > >>>> HR: 158, sinus arrhythmia, strong pulse > >>>> BP: 98/56 > >>>> > >>>> Mental status: she is not responsive enough to answer questions or > >>>> follow > >>>> commands. Reaction to pain before RSI is NOT noted. > >>>> > >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > >>>> mucosa is NOT pale. Gag Reflex is absent > >>>> > >>>>> What would be the effective Glasgow Coma Score of this patient? > >>>> > >>>> Neck: no nodes or obvious nuchal rigidity > >>>> > >>>> Chest and Abdomen findings are NOT reported. > >>>> > >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > >>>> NOT > >>>> a buboe. > >>>> > >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No > >>>> > >>>> evidence of arachnid bites or stings are noted. > >>>> > >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > >>>> reported. > >>>> > >>>> Working evaluation: Obtunded patient with ongoing seizures and > >>>> ventilatory > >>>> compromise, significant hypothermia. > >>>> > >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > >>>> given, and the seizures stop for less than one minute before tremors > >>>> which > >>>> progress to grand mal activity start. Core Body temp does NOT respond to > >>>> > >>>> environmental temperature and aggressive warming > >>>> > >>>>> note: WHY are you hanging around to try to warm this patient? > >>>> > >>>> Repeat VS: > >>>> o2: 96% on 15 LPM NRB > >>>> RR: 6, very shallow and erratic, no gag reflex > >>>> HR: 164, sinus arrhythmia, strong pulse > >>>> BP: 94/52 > >>>> > >>>>> At this point, more aggressive ventilatory support should be started. > >>>> Question for the group: > >>>> a: name *at least* two reasons for the decrease in ventilatory effort? > >>>> b: name *at least* two methods for supporting ventilation? > >>>> > >>>> Further Treatment: The patient is set up for RSI- the seizures stop for > >>>> 'a > >>>> few minutes' under the influence of the paralytics. Phenobarbital is > >>>> loaded, but is no more effective than Benzos at terminating the > >>>> seizures, as > >>>> they reported restart shortly after the loading drip is complete. > >>>> > >>>>> note: this is VERY unusual for seizures. question for the group: What > >>>> is > >>>> the next step in the treatment of the seizures *besides* transport. > >>>> > >>>> Active methods to support ventilation is NOT specified. > >>>> > >>>> Transport issues: You have one ER without so much as a dedicated > >>>> pediatrician which is about 5-10 min northwest, and one which is a > >>>> dedicated > >>>> children's hospital 30-40 minutes in the opposite direction. The two > >>>> closest > >>>> flight teams are out on other calls, and consequently their ETA is worse > >>>> than > >>>> yours. > >>>> > >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT > >>>> > >>>> your run of the mill pediatrician! > >>>> > >>>> I agree, there is significant internal derangement of this patient. As > >>>> Ms. > >>>> Wood has already noted that the diagnosis was difficult even in the ED, > >>>> I > >>>> doubt anyone will guess correctly at this point. > >>>> > >>>> What is next? > >>>> > >>>> ck > >>>> > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 No tumors. Alyssa Woods, NREMT-B > Belay that last. Hypothalamic hamartoma. > > Wes > > On the move from my iPhone > > > > > Hypothalamic epilepsy is coming to mind. > > > > Wes > > > > On the move from my iPhone > > > > > > > > > What about the hypothalamus? > > > > > > And Mr Sharp - no dehydration. > > > > > > > > > > > > Alyssa Woods, NREMT-B > > > > > > > > > > > > > > > > > >> Hypothalamus? > > >> > > >> Wes > > >> > > >> On the move from my iPhone > > >> > > >> > > >> > > >>> Ok; any guesses as to what is going on in her skull? I will accept both the condition she has and what it's led to. > > >>> > > >>> You're going along the right track; I don't care what " Dr House " says; sometimes, it really is just a coincidence. > > >>> > > >>> > > >>> Let's review our hints. > > >>> > > >>> It's not external, it's internal. > > >>> The temperature is important. > > >>> It's an act of God that man can fix. > > >>> It's chronic, and focal. > > >>> We create something kind of similar in dialysis patients; in her we must undo it. > > >>> > > >>> > > >>> Alyssa Woods, NREMT-B > > >>> > > >>> > > >>> > > >>> > > >>> > > >>> > > >>>> Do we have two different things going on here? Perhaps the seizure is > > >>>> related to an underlying issue in her skull that was set off by the > > >>>> relatively minor injury that caused the scrape on the chin and an > > >>>> undiagnosed oncology issue that is related to the lymph node. > > >>>> > > >>>> If not, then my guess is that it was Col. Mustard in the drawing room > > >>>> with the monkey wrench. > > >>>> > > >>>> Great mystery diagnosis....it's been fun watching the discussions and > > >>>> thought processes going on. > > >>>> > > >>>> Barry > > >>>> > > >>>> Barry Sharp, MSHP, MCHES > > >>>> > > >>>> Tobacco Prevention & Control Program Coordinator > > >>>> > > >>>> Substance Abuse Services Unit > > >>>> > > >>>> Mental Health and Substance Abuse Division > > >>>> > > >>>> > > >>>> > > >>>> ________________________________ > > >>>> > > >>>> From: texasems-l [mailto:texasems-l ] On > > >>>> Behalf Of Henry Barber > > >>>> Sent: Wednesday, July 13, 2011 7:09 AM > > >>>> To: texasems-l > > >>>> Subject: Re: Mystery Diagnosis > > >>>> > > >>>> I think she was bitten by a bat while removing a tic. This has been a > > >>>> tough one. I have been waiting for Mr. Gandy to pop in and say " AW thats > > >>>> an easy one " and give us the answer. > > >>>> > > >>>> Henry > > >>>> Re: Mystery Diagnosis > > >>>> > > >>>> OK, let's see if I can sum up the current findings of the last 40 odd > > >>>> messages. My comments are in line at >: > > >>>> > > >>>> Chief Complaint: New Onset Seizure > > >>>> > > >>>> History of Present Illness: 5 yo WF previously in good health, noted to > > >>>> have major convulsions after playing outside on a hot afternoon. Onset > > >>>> is un > > >>>> certain as the parents were unpacking from the recent move. The > > >>>> convulsions > > >>>> continued for at least 5 minutes, and recurred after appropriate initial > > >>>> > > >>>> treatment. > > >>>> > > >>>> Past History: no medical or surgical history, no allergies, no > > >>>> medications. > > >>>> > > >>>> Social history is positive for a pregnant mother who is slightly > > >>>> overdue, > > >>>> Just moved into a new house with a koi pond, but no plants besides > > >>>> grass, > > >>>> and no known history of chemical usage in the hard or pond > > >>>> > > >>>>> Is there anything interesting in the Family History > > >>>> > > >>>> Review of Systems: The node noted on the physical exam has been present > > >>>> for a week, and child has an appointment with her (? new) pediatrician > > >>>> already scheduled. > > >>>> > > >>>> Physical exam is positive for > > >>>> > > >>>> VS: Hypothermic at 95 F Rectal, o2: 90% room air > > >>>> RR: 8, very shallow and erratic, no gag reflex > > >>>> HR: 158, sinus arrhythmia, strong pulse > > >>>> BP: 98/56 > > >>>> > > >>>> Mental status: she is not responsive enough to answer questions or > > >>>> follow > > >>>> commands. Reaction to pain before RSI is NOT noted. > > >>>> > > >>>> HEENT: small abrasion on the chin, pupils are equal but very sluggish. > > >>>> mucosa is NOT pale. Gag Reflex is absent > > >>>> > > >>>>> What would be the effective Glasgow Coma Score of this patient? > > >>>> > > >>>> Neck: no nodes or obvious nuchal rigidity > > >>>> > > >>>> Chest and Abdomen findings are NOT reported. > > >>>> > > >>>> Extremities: a solid unilateral R inguinal/thigh node is noted. It is > > >>>> NOT > > >>>> a buboe. > > >>>> > > >>>> Skin: aside from the abrasion, there are no rashes or bruising noted. No > > >>>> > > >>>> evidence of arachnid bites or stings are noted. > > >>>> > > >>>> Neurologic: Babinski's reflex is normal. Deep tendon Reflexes are NOT > > >>>> reported. > > >>>> > > >>>> Working evaluation: Obtunded patient with ongoing seizures and > > >>>> ventilatory > > >>>> compromise, significant hypothermia. > > >>>> > > >>>> Treatment: Open Airway, apply oxygen, establish IV Access. IV ativan is > > >>>> given, and the seizures stop for less than one minute before tremors > > >>>> which > > >>>> progress to grand mal activity start. Core Body temp does NOT respond to > > >>>> > > >>>> environmental temperature and aggressive warming > > >>>> > > >>>>> note: WHY are you hanging around to try to warm this patient? > > >>>> > > >>>> Repeat VS: > > >>>> o2: 96% on 15 LPM NRB > > >>>> RR: 6, very shallow and erratic, no gag reflex > > >>>> HR: 164, sinus arrhythmia, strong pulse > > >>>> BP: 94/52 > > >>>> > > >>>>> At this point, more aggressive ventilatory support should be started. > > >>>> Question for the group: > > >>>> a: name *at least* two reasons for the decrease in ventilatory effort? > > >>>> b: name *at least* two methods for supporting ventilation? > > >>>> > > >>>> Further Treatment: The patient is set up for RSI- the seizures stop for > > >>>> 'a > > >>>> few minutes' under the influence of the paralytics. Phenobarbital is > > >>>> loaded, but is no more effective than Benzos at terminating the > > >>>> seizures, as > > >>>> they reported restart shortly after the loading drip is complete. > > >>>> > > >>>>> note: this is VERY unusual for seizures. question for the group: What > > >>>> is > > >>>> the next step in the treatment of the seizures *besides* transport. > > >>>> > > >>>> Active methods to support ventilation is NOT specified. > > >>>> > > >>>> Transport issues: You have one ER without so much as a dedicated > > >>>> pediatrician which is about 5-10 min northwest, and one which is a > > >>>> dedicated > > >>>> children's hospital 30-40 minutes in the opposite direction. The two > > >>>> closest > > >>>> flight teams are out on other calls, and consequently their ETA is worse > > >>>> than > > >>>> yours. > > >>>> > > >>>>> incidentally, this is a case where the patient needs a good EM doc, NOT > > >>>> > > >>>> your run of the mill pediatrician! > > >>>> > > >>>> I agree, there is significant internal derangement of this patient. As > > >>>> Ms. > > >>>> Wood has already noted that the diagnosis was difficult even in the ED, > > >>>> I > > >>>> doubt anyone will guess correctly at this point. > > >>>> > > >>>> What is next? > > >>>> > > >>>> ck > > >>>> > > >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 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 > Dehydration? > > 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 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 > Dehydration? > > 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 Alzheimer's or Parkinson's come to mind for much older patients. Wes On the move from my iPhone > 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 > > > > > > >> Dehydration? >> >> 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 Alzheimer's or Parkinson's come to mind for much older patients. Wes On the move from my iPhone > 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 > > > > > > >> Dehydration? >> >> 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 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 > > > > > 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 > > > > > > > > > > > > > >> Dehydration? > >> > >> 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 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 > > > > > 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 > > > > > > > > > > > > > >> Dehydration? > >> > >> 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 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 > > > > > 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 > > > > > > > > > > > > > >> Dehydration? > >> > >> 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 Cerebral Aneurysms? 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 Cerebral Aneurysms? 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 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 > > > > 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 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 > > > > 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 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 >> >> >> >> 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 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 >> >> >> >> 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 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 >> >> >> >> 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 Cerebral Amyloid angiopathy.... or AV malformation.... Christie Hale ---- Alyssa Woods amwoods8644@...> wrote: > 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 > > > > > > > > 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 Cerebral Amyloid angiopathy.... or AV malformation.... Christie Hale ---- Alyssa Woods amwoods8644@...> wrote: > 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 > > > > > > > > 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...
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