# 23 yom with strange symptoms.



## NRNCEMT (May 4, 2009)

This isn't a call I went on, he said that he was feeling funny.  Took his BP and it was 161/115 with a pulse of 110, 22 rpm.  He wasn't diaphoretic and wasn't c/o of chest pains.  But what struck me funny was that he said he was having bouts of full body numbness, even his scalp.  I had him sit down and we talked a little bit about non-sickness related topics and I checked his BP again after about 10 min and it came down to 157/97, same pulse, and only 18-20 rpm.  Since I wasn't near my department I couldn't request a truck, so I called his mother and father and told them that they need to take him to the ER.

A little PMHX from this person.  I'm not sure if he still does, but he use to snort cocaine a lot in the past, and use to and still does pills.

He said that he only took 2 perc 512's today for his torn muscle that he recently got...yeah, I know, torn muscle my a**.

I'm wondering what others think about this one.  My guess would be HTN with maybe a little neuropathy?  I'm hoping not, but maybe TIA's?


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## MSDeltaFlt (May 4, 2009)

NRNCEMT said:


> This isn't a call I went on, he said that he was *feeling funny. Took his BP and it was 161/115 with a pulse of 110, 22 rpm*. He wasn't diaphoretic and wasn't c/o of chest pains. But what struck me funny was that *he said he was having bouts of full body numbness, even his scalp*. I had him sit down and we talked a little bit about non-sickness related topics and I checked his BP again after about 10 min and it came down to 157/97, same pulse, and only 18-20 rpm. Since I wasn't near my department I couldn't request a truck, so I called his mother and father and told them that they need to take him to the ER.
> 
> A little PMHX from this person. *I'm not sure if he still does, but he use to snort cocaine a lot in the past, and use to and still does pills*.
> 
> ...


 
Sounds to me like he was stoned.


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## Onceamedic (May 4, 2009)

possibly anxiety - talking with him calmed him down...  

(and stoned of course)


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## NRNCEMT (May 4, 2009)

Kaisu said:


> possibly anxiety - talking with him calmed him down...
> 
> (and stoned of course)



No, he wasn't stoned...and as much as he was freaking out about the symptoms he would have lost his buzz a long time ago.


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## WannaBeFlight (May 5, 2009)

Anxiety and Panic Attacks do cause the increase HR and BP, and some people have shown sx of numbness, some in their hands, others their feet, even had one girl say she had numbness in her face, neck and shoulder. Odd, but it does happen. It would explain the decrease in his vitals a few minutes later.


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## daedalus (May 5, 2009)

Anxiety or drugs.


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## emtjack02 (May 5, 2009)

Did his numbness go away once the BP was lower?  HTN can manifest it's self in different ways.  I would wonder about end organ damage r/t drug use.


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## NRNCEMT (May 7, 2009)

emtjack02 said:


> Did his numbness go away once the BP was lower?  HTN can manifest it's self in different ways.  I would wonder about end organ damage r/t drug use.



He said the numbness would come and go, not just localized but full body numbness.  He noted that he had taken the 2 percs that morning and he came to me late that evening.


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## VentMedic (May 7, 2009)

NRNCEMT said:


> was feeling funny.
> 
> his BP and it was *161/115* with a pulse of 110, 22 rpm.
> 
> ...


 
Were you using a manual or electronic BP cuff? 

You have also described common symptoms of drug reactions and interactions. I usually hear the same complaints and see the same vital signs when I give an albuterol and the patient forgets to tell all the OTC meds they have taken. If the symptoms persist the patient gets a monitored bed in the ED or on tele. 

Did you see the prescription bottle for the percocets? The date? Which muscle was injured? Any sign of inflammation? Limited motion or numbness when the extremity is manipulated? Equal strength in extremities? Gait? 

Pupils: size and reaction? 

Or, did this attitude prevent you from objectively assessing this patient?


> yeah, I know, torn muscle my a**.


 
Since the BP only varied by 4 mmHg, that could also be attributed to operator variance. The 2nd BP is still high for a 23 y/o. 

I would also consider the function of the liver, kidneys and heart from past drug use. Damage to the liver and kidneys would also impair drug elimination and have prolonged or profound effect when certain meds are taken and/or mixed. 

At least you did send him to the ED.


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## NRNCEMT (May 7, 2009)

VentMedic said:


> Were you using a manual or electronic BP cuff?
> 
> You have also described common symptoms of drug reactions and interactions. I usually hear the same complaints and see the same vital signs when I give an albuterol and the patient forgets to tell all the OTC meds they have taken. If the symptoms persist the patient gets a monitored bed in the ED or on tele.
> 
> ...



1st off, I don't judge my patients on any level when trying to help.

Manuel cuff, did not see the bottle of percs, he said it was a torn muscle in his chest (from what the ED told him), eyes were PEARL, he didn't have any signs of weakness in any extremities.  The reason I know quite a bit about this guy is because him and I were good friends growing up in the neighborhood and was a pill chaser.  Our paths split when he began the real hard stuff (cocaine, heroin, meth).

Hope that helps.


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## MSDeltaFlt (May 7, 2009)

NRNCEMT said:


> 1st off, I don't judge my patients on any level when trying to help.
> 
> Manuel cuff, did not see the bottle of percs, he said it was a torn muscle in his chest (from what the ED told him), eyes were PEARL, he didn't have any signs of weakness in any extremities. The reason I know quite a bit about this guy is because him and I were good friends growing up in the neighborhood and was a pill chaser. Our paths split when he began the real hard stuff *(cocaine, heroin, meth)*.
> 
> Hope that helps.


 
If it's not drugs, it's psych.


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