# 12Y M Dizzy/Nausea/Headache



## RedAirplane (Apr 20, 2015)

You are called to a school in the evening for a parent/teacher/student event of sorts.

The patient is a 12 year old male sitting on a staircase with his dad. First responders advise that the pt is complaining of worsening dizziness and new headache and new nausea. The father advises that he is concerned even though his son is a bit of a hypochondriac, because he's never been dizzy until today, and the mom/dad have had vertigo in the past.

You get on the patient's level and ask some questions. He says that the dizziness was mild in the morning, went away, and then came back in the evening and has been worsening. He can't stand up because the room is spinning. Nausea and headache have been new developments, but no vomiting. V/S WNL. Pt says he is a little cold so you give him a blanket.

You transport with no further complication. If you had to venture a guess, what's going on?


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## STXmedic (Apr 20, 2015)

With limited information, ear infection and vertigo would be high up on my list.


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## COmedic17 (Apr 20, 2015)

Vertigo, ear infection, or he successfully avoided parent teacher conferences that otherwise would of ended badly.


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## Flying (Apr 20, 2015)

Last couple of meals/oral intakes, any swimming,  any allergies? I would lean towards ear troubles.


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## Underoath87 (Apr 20, 2015)

COmedic17 said:


> Vertigo, ear infection, or *he successfully avoided parent teacher conferences that otherwise would of ended badly.*



Haha, probably a big helping of this.


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## COmedic17 (Apr 21, 2015)

Underoath87 said:


> Haha, probably a big helping of this.


Oh yes. I'm a mother. I know how they think lol. 

" your dizzy? Well your pulse and cap refill look great. You suddenly can't stand  once we get to the school? How convenient. Dad will piggy back you. Yes, in front of your friends. Nausea? Your skin vitals are fantastic and you have yet to puke. You have a headache?Take this Tylenol. Since your stable, we will continue with parent teacher conferences. If your still ill after, I will call your PCP. " 

My children sometimes despise having two paramedics as parents. 
*evil laugh*


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## COmedic17 (Apr 21, 2015)

My daughter routinely gets "sick" before she has to get shots. Very convenient.


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## RedAirplane (Apr 21, 2015)

Had a hot dog at lunch. Not much to drink all day.

I'll also admit that the part about the parent/teacher conference was made up to prevent this scenario from being tied to a real patient. Suffice it to say it's a venue that the pt would like to fully engage at.


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## Brandon O (Apr 21, 2015)

Did you do an exam?


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## COmedic17 (Apr 21, 2015)

You do know you don't have to change the entire scenario to avoid HIIPA, right? If you change everything about a story no one can give you advice/feedback on what they would do since it's a completely different situation. 

Leaving out the location (don't give the name of the school or school district) leaving out the name (obviously) and leaving out the day it happened and maybe slightly changing the age should suffice.


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## Kaleb Griffin (Apr 21, 2015)

I wouldn't say that it was an ear infection if VS are WNL...unless there is an atypical presentation elsewhere.  I would learn towards vertigo just because of the family hx.  Possibly look into Meniere's disease.


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## STXmedic (Apr 21, 2015)

I've had more ear infections than I can count, and they've never affected my vitals.

Edit: I'm sure when I was a baby I would get tachy from being pissed/in pain. Otherwise no, no change in vitals.


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## Kaleb Griffin (Apr 21, 2015)

STXmedic said:


> I've had more ear infections than I can count, and they've never affected my vitals.
> 
> Edit: I'm sure when I was a baby I would get tachy from being pissed/in pain. Otherwise no, no change in vitals.


That's may be true for some, but not every patient presents the same way.  Also, the patient is at an age range where most people usually outgrow ear infections, even years before that.  But again, weigh all options just to be safe.


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## STXmedic (Apr 22, 2015)

Kaleb Griffin said:


> *That's may be true for some, but not every patient presents the same way*.  Also, the patient is at an age range where most people usually outgrow ear infections, even years before that.  But again, weigh all options just to be safe.


Exactly. So why would you say it's not an ear infection? I stand by my point, typically ear infections do not significantly alter vitals. There may be a fever, but even a lack of one is hardly cause for rule-out. And while ear infections are certainly much more prevalent in young kids, like you said- true for some, but not all. I still get them, and have made plenty of teens and adults with them. It's by no means uncommon.


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## COmedic17 (Apr 22, 2015)

Kaleb Griffin said:


> That's may be true for some, but not every patient presents the same way.  Also, the patient is at an age range where most people usually outgrow ear infections, even years before that.  But again, weigh all options just to be safe.


I routinely get ear infections... I'v had more ear infections in the past year then my toddler.


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## Brandon O (Apr 22, 2015)

COmedic17 said:


> I routinely get ear infections... I'v had more ear infections in the past year then my toddler.



Might want to chat with an ENT.


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## Tigger (Apr 22, 2015)

Ebola hath returnded.


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## COmedic17 (Apr 22, 2015)

Brandon O said:


> Might want to chat with an ENT.


I've had tubes twice. 


There's no helping me. Lol


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## RedAirplane (Apr 23, 2015)

Tigger said:


> Ebola hath returnded.



Didn't even think of that. They don't issue us space suits!


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## MedicMan (Apr 25, 2015)

Kaleb Griffin said:


> That's may be true for some, but not every patient presents the same way.  Also, the patient is at an age range where most people usually outgrow ear infections, even years before that.  But again, weigh all options just to be safe.


Ya know, I've been trying to get the patients to read the textbook,  but they just wont follow directions... Lol!


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## Kaleb Griffin (Apr 25, 2015)

MedicMan said:


> Ya know, I've been trying to get the patients to read the textbook,  but they just wont follow directions... Lol!


If only, right? lol


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