Things are not always what they seem

[VirginiaEMT]

I ran a call that turned out to be a female patient sitting in the road in front of 2 police cars upon our arrival. They had wrapped her an emergency blanket. She was alert to verbal stimuli and was able to give me her first name and that is about it. It was in a rough area of town, approx. 50 degrees, and clear weather. This area is known for drugs and drunks. This lady presented as a druggie or a drunk but had no smell of alcohol on her. She had been assaulted it appeared as she had a large hematoma on her eye and one on her forehead, both with controlled bleeding.

Upon placing her in our unit and performing an assessment here is what I found....

1. The hematomas
2. A wrist bracelet from the local hospital where she had just been discharged from the O.B ward and she still appeared pregnant
3. Vitals included BP 220/178, Pulse 60, Resp. 18 irregular, Pupils constricted/fixed. I'm thinking head bleed from the trauma to the head
4. Hypoglycemic- 57

Far bigger problems than I thought I had when I saw he sitting in the street. Oh yeah, she was post-partum as she had a baby 3 days before according to the hospital.

Here is a question I would like you opinion on. The hospital said this lady's core temperature was 27.1 Celsius. (80.8 F). How could this lady have been able to communicate with me at this temperature? Have you ever had a hypothermic patient this cold before? I can see her getting this cold if it was very cold outside, snowing, raining, etc. but it was at least 50 degrees.

 

[Rano Pano]

I would think the average pt wouldn't be able to communicate with a temp like that. In fact I'd assume they'd be in or real close to v-fib. That being said if in fact the temp was correct and the pt presented how they did I'd think that's a awesome example how everyone's body reacts different.

As far as how she got that cold....where was the pt the last 3 days? Outside on the floor?

All in all I'd be leaning toward you were reported the wrong temp, but who knows...

 

[TheLocalMedic]

I'm thinking that the temp was wrong as well. I have had a severely hypothermic patient who was at 85 F, but they were completely unresponsive at that point.

 

[VirginiaEMT]

I'm thinking that the temp was wrong as well. I have had a severely hypothermic patient who was at 85 F, but they were completely unresponsive at that point.

This patient was very altered but she was able to communicate well enough to tell me her name, although mumbling, but she did go unresponsive a couple of times for a brief second.

She had her baby 3 days prior so she had probably only been out of the hospital for a day. I couldn't read the bracelet.

I still think she had a head bleed because of the BP, Heart rate, and respirations.

 

[jwk]

Not saying anyone is wrong - but I'm always very suspicious when vitals are that out of whack that there is some "operator error".

Even if she had been eclamptic/pre-eclamptic prior to delivery - or from the head injury, that is a whopping diastolic BP. Was this patient shivering at all? What was her BP on arrival at the ED? I don't know that I've ever seen a diastolic BP that high.

What's the source of the temp? Having been outside in a relatively cool area, I'm not trusting anything oral/TM/axillary/skin to give me any useful information. Unless that temp was from a rectal probe, I'd have a big question mark about that temp especially with a patient that's still conscious and communicating.

 

[blindsideflank]

Forget the thermometer. From a physical assessment was this person that cold (touch, colour etc.?)
That cold is unreliable without an internal temp anyways

 

[mycrofft]

Anyone ever see a human thermometer which read as low as 80 deg F.? Or is there a C. to F. issue?

Was theirs an actual core temp? I've witnessed where a nurse took a tympanic temp and declared it a core temp.

MOST digital thermometers, unless directed otherwise, measure temp for about five seconds then use an algorithm to deduce correct temp. Especially if the exterior is cold, set it on "monitor" and not "auto". Takes longer.

In a thread I started a few days ago I cited a woman complaining of being very cold (she was) and her pupils were pinpointed. Wonder if the cold can do it too? It makes other things get smaller.
Like capillaries.

 

[Handsome Robb]

I've had two very hypothermic patients that were still communicating albeit poorly. Both were <85* rectally and I trust the number because it's from the continuous temp probe from our monitor.

 

[Aidey]

3. Vitals included BP 220/178, Pulse 60, Resp. 18 irregular, Pupils constricted/fixed. I'm thinking head bleed from the trauma to the head
4. Hypoglycemic- 57

With that BP, she could also have preeclampisa. Pre/eclampsia can develop up to 6 weeks post partum.

 

[abckidsmom]

Anyone ever see a human thermometer which read as low as 80 deg F.? Or is there a C. to F. issue?

Was theirs an actual core temp? I've witnessed where a nurse took a tympanic temp and declared it a core temp.

MOST digital thermometers, unless directed otherwise, measure temp for about five seconds then use an algorithm to deduce correct temp. Especially if the exterior is cold, set it on "monitor" and not "auto". Takes longer.

In a thread I started a few days ago I cited a woman complaining of being very cold (she was) and her pupils were pinpointed. Wonder if the cold can do it too? It makes other things get smaller.
Like capillaries.

Sounds like a typo to me. 37.1 is what I'd expect. Even the coldest people with hypothermia are 32-33. You can be awake with a pulse at 27. That's a no.

I agree with Aidey. The hoofbeats in this scenario sound like the horses of an OB problem and not the zebras of a head bleed.

 

[VirginiaEMT]

Sounds like a typo to me. 37.1 is what I'd expect. Even the coldest people with hypothermia are 32-33. You can be awake with a pulse at 27. That's a no.

I agree with Aidey. The hoofbeats in this scenario sound like the horses of an OB problem and not the zebras of a head bleed.

I overheard the nurse tell the doctor that it was 27.1C and he didn't correct or ask questions. But I can't see anyone getting that cold in the weather we had that morning, and she had on a sweatshirt, shirt under it, blue jeans, shoes, etc. She may have been chilly outside but definitely not freezing cold.

If it was preeclamsia/eclampsia, why would her breathing pattern have been so irregular? I verified this with capnography. JUST CURIOUS!