# weird call



## Medic87 (Oct 15, 2011)

You get dispatched to a 95 y/o Male, c/o can't stop shaking. On arrival you see a male laying in his bed AOx4 GCS15 states that he feels fine and he doesn't want to go to the hospital .The pt's CNA states that he started shaking two hours ago and couldn't stop shaking since then . As you try to put a BP cuff on him,he vomits right in front of you. 
BP-160/90,Pulse-64 regular and strong,Resp-14 regular and normal,BGL-80,Sat-96,end tidal 40,Temp-99.6,eyes PERL
After a physical exam was performed CVA was ruled out. Pt has a history of A-fib ,ESRD,Hypertension, he takes Lasix ,Digoxin , and Betta blockers. 12 Lead revealed a normal sinus and no ST elevation.

Your thoughts????


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## IRIDEZX6R (Oct 15, 2011)

Medic87 said:


> You get dispatched to a 95 y/o Male, c/o can't stop shaking. On arrival you see a male laying in his bed AOx4 GCS15 states that he feels fine and he doesn't want to go to the hospital .The pt's CNA states that he started shaking two hours ago and couldn't stop shaking since then . As you try to put a BP cuff on him,he vomits right in front of you.
> BP-160/90,Pulse-64 regular and strong,Resp-14 regular and normal,BGL-80,Sat-96,end tidal 40,Temp-99.6,eyes PERL
> After a physical exam was performed CVA was ruled out. Pt has a history of A-fib ,ESRD,Hypertension, he takes Lasix ,Digoxin , and Betta blockers. 12 Lead revealed a normal sinus and no ST elevation.
> 
> Your thoughts????



Food poisening, fever, spider bite? Lots of things can cause vomiting/shaking.


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## fast65 (Oct 15, 2011)

Did he have any complaints of visual disturbances? Was there anything abnormal about the vomit?

Any changes on the 12-lead outside of ST changes?

At this point I'm kind of looking at possible digoxin toxicity.


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## skivail (Oct 15, 2011)

when was his last dialysis?


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## Chief Complaint (Oct 16, 2011)

fast65 said:


> Did he have any complaints of visual disturbances? Was there anything abnormal about the vomit?
> 
> Any changes on the 12-lead outside of ST changes?
> 
> ...



Thinking the same thing.

Any chance you have the 12 lead handy?


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## fast65 (Oct 16, 2011)

skivail said:


> when was his last dialysis?



Where did you read he was a on dialysis?


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## MedicBender (Oct 16, 2011)

fast65 said:


> Where did you read he was a on dialysis?
> 
> 
> Sent from my iPhone using Tapatalk



I would assume that as well with the end stage renal disease (ESRD)


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## fast65 (Oct 16, 2011)

MedicBender said:


> I would assume that as well with the end stage renal disease (ESRD)



Oh, sorry, I wasn't paying attention again, disregard my previous statement 


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## NomadicMedic (Oct 16, 2011)

Need to do some additional detective work here.

What had he been doing prior to the event? Any med changes? Different foods? Recent illness? Last Dialysis? Was the 12 lead suspiscious for Dig toxicity, ie: a prolonged P-R? Did he become more bradycardic as the call progressed? Any changes in vision? Was he orthostatic? Did he have any mental status changes?

I mean... there's a lot of stuff you can add in to this to help us...

Without more details that'll sway me, I'd lean toward a gastro issue. He's slightly febrile and vomiting.


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## DV_EMT (Oct 22, 2011)

fast65 said:


> Did he have any complaints of visual disturbances? Was there anything abnormal about the vomit?
> 
> Any changes on the 12-lead outside of ST changes?
> 
> ...



With digoxin toxicity, ECG chages can show be inverted T wave, PR interval prolongation, and bradycardia. If the 12 lead showed none of these, I'd doubt it was digoxin toxicity unless it was too early to present itself.

The shaking and vomiting could point to neurological complications, could the fever be part of it? Could he be having a "pseudo" febrile seizure? 

What'd he eat in the last 24 hrs? What color was his vomit? When was his last dialysis? any other Ectopy with the ECG? Has he fallen at all? Hows his cardiac perfusion? SPO2 and skin teger?


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## Brandon (Oct 25, 2011)

Rapid Transport..


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## STXmedic (Oct 25, 2011)

Brandon said:


> Rapid Transport..



Not sure if serious...


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## fast65 (Oct 25, 2011)

Brandon said:


> Rapid Transport..



Ummm, is that it?


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## Handsome Robb (Oct 25, 2011)

I'm on the dig tox train as well.

No anticoagulants with hx of A-fib?

I wouldn't exactly call him febrile at 99.6 either...

This thread kinda fell on it's face.


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## mycrofft (Oct 25, 2011)

*99.6 could be due to the tremoring.*

Sidebar...since I was put on beta blockers I often experience a barely perceptible fine "vibratory" tremor all over my body. (Cue the Flip WIlson jokes). Wonder if that has any bearing? 
I've seen some people with alarming "essential tremor" but are perfectly ok otherwise.
Oh, yeah, a thought...ETOH detox?


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## Handsome Robb (Oct 25, 2011)

Mycrofft has a very good point. Our body's best way of producing heat is shivering. Tremors would produce similar heat to this, thus increasing your body temp.

ETOH detox is definitely a good thought although there's no history but people lie. It comes down to how reliable the patient and the history the caretaker is provided though.


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## mycrofft (Oct 25, 2011)

*detox (did it for six years)*

The young guys lie to get benzos, the old guys lie to stay out of jail or lockdown ward.


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