# Paralysis negative for trauma



## EMTGunney (Mar 2, 2011)

25 yo male C/O paralysis below the neck but occasionally responds to pain pt denies trauma. pt also has an elevated respiratory rate with limited success with pt control of respiratory rate. pt also works as a deliverer for a mail company.


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## Aidey (Mar 2, 2011)

Do you have a question? Is this a scenario?


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## EMTGunney (Mar 2, 2011)

*What do u think is the NOI*



Aidey said:


> Do you have a question? Is this a scenario?



both yes this is a Scenario i had this pt a couple weeks ago, the question is what do u think the NOI was


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## usafmedic45 (Mar 2, 2011)

EMTGunney said:


> both yes this is a Scenario i had this pt a couple weeks ago, the question is what do u think the NOI was


About thirty different things.  You'll have to give us more if you want to not just have a meaningless list of differentials.


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## Aidey (Mar 2, 2011)

I suggest you look at some of the threads in the "Scenarios" section and model your post after those if you really want people to read and respond.


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## EMTGunney (Mar 2, 2011)

*additional info.*



usafmedic45 said:


> About thirty different things.  You'll have to give us more if you want to not just have a meaningless list of differentials.



ok so 12-lead was NSR HR was 100, SPO2% was 98%, BP was 150/P, respirations were 30-40 shallow. breathe sounds were wheezing bilaterally. BGL was with in normal limits. pupils were equal and reactive to light, negtive for halo test. negative for DCAP-BTLS. ohhh and pt was experiencing loss of sight and hearing.


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## Veneficus (Mar 2, 2011)

With respect, 

I think you need to learn how to present a case. 

There are several examples in the scenario group


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## Bieber (Mar 2, 2011)

Yeah, gonna need a little more from you.

How about an OPQRST-ASPN and SAMPLE?


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## EMS49393 (Mar 2, 2011)

EMTGunney said:


> ok so 12-lead was NSR HR was 100, SPO2% was 98%, BP was 150/P, respirations were 30-40 shallow. breathe sounds were wheezing bilaterally. BGL was with in normal limits. pupils were equal and reactive to light, negtive for halo test. negative for DCAP-BTLS. ohhh and pt was experiencing loss of sight and hearing.



Yeah, um.  A heart rate of 100 and greater is a tachycardia.  There is no such thing as "normal" sinus rhythm.  It's a sinus rhythm and it can look different on everyone.  SPO2 means he is apparently perfusing his extremities.  Why did you get a palp BP?  You can not treand MAP with a palp pressure.  If you do not treand MAP, you'll put yourself behind the 8-ball with ICP.  Why is ICP an issue in this patient?  This could very well be a neurological issue, especially when you add the sight and hearing aspect.  Anyone consider some EtCO2 with his wheezing and rapid and shallow respiratory finding?

Where did you ascultate lung sounds?  Did you just check the anterior chest at the mid-clavicular line around the 2nd rib, or did you check all the ascultation points?  Upper and lower anterior chest, lateral chest mid-axillary, and upper, mid, and lower posterior torso?  Did you listen to heart sounds?  Did you hear S1 and S2 with no other funky sounds?  You don't necessarily need to know all the heart sounds, but you need to know S1 and S2 and if you hear anything that is not either of those.  That could be an important finding.  

Did you check radial and pedal pulses?  Why is that important?  Hint, it is very important, especially in a non-traumatic possibly paralyzed patient.

What do you mean by paralyzed from below the neck?  Where does it start below the neck?  Someone that is paralyzed at the neck would likely not be breathing on their own.  So that leads my next question... is he really paralyzed or is he saying he can't move?  Did you really check his pain response?  How far down the body did you check his pain response?

Medical history, medications, allergies, pertinent information regarding what he was doing when the event occurred would all be nice.  Is he somewhat psych and put over the edge because he's fighting with his woman?  This is all stuff you either didn't think of, didn't think to evaluate, or you're not telling us your entire assessment.

Did you make him naked so you could do a thorough physical exam?  We carry gowns, and sheets, and blankets.  They won't be naked for long, but if you fail to make them naked, you could fail to find something very important.

We can not help you unless you present the ENTIRE case.  Now, go back and try again.


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## TransportJockey (Mar 2, 2011)

Since you don't have enough information to base anything on... I'm gonna throw out a WAG. Clostridium botulinum


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## jjesusfreak01 (Mar 3, 2011)

Panic attack perpetuated by the symptoms of a panic attack, that being tingling in the extremities, rapid heart and respiratory rates, and generally really stupid complaints.


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## seekersofthetruth (Mar 4, 2011)

jjesusfreak01 said:


> Panic attack perpetuated by the symptoms of a panic attack, that being tingling in the extremities, rapid heart and respiratory rates, and generally really stupid complaints.



This is my take on it too. D'Dx could be Botulism or Guillain-Barre Syndrome or about a dozen other neurological disorders.


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## IAFF GUY (Jul 19, 2011)

"Regretfully the ignorance of US EMS providers is more than I can bear.

I have much to do, and have clearly wasted too much time here". 

The arrogance of non-US people is more than irritating.  Please excuse some of those who may be new (beneath your appearant "superior" attitude)  give the guy a chance you ***.


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