# Try this one



## crazycajun (May 20, 2011)

17yo male involved in roll over MVC. Has fracture to right clavicle and left fib,tib and femur. Alert and Responsive to verbal Sp O2 96 BP 130/70 RR27 BPM88. Patient air lifted to ER and brought into surgery to repair fractures. 4 hours of surgery patient recovers and sent to room. 4 hours later PT complains of chest feeling heavy put on NC @4lpm nurse claims due to anesthesia. 1 hour later PT still has chief complaint of difficult to breath placed on NRB @15 lpm nurse still states due to anesthesia. 2 hours later dad walks in finds son unresponsive and hypoxia. Immediately hits code switch. PT rushed to CICU with Sp O2 27 BP 80/40 RR 9. PT has no previous med Hx and is in excellent physical condition. Non smoker, drinker or drug user. (BTW I am the dad. Happened 5 years ago)
Can you guess what happened and outcome?


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## JPINFV (May 20, 2011)

Pulmonary embolism?


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## abckidsmom (May 20, 2011)

Bone marrow embolus.


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## crazycajun (May 20, 2011)

You are both correct. The BME or FES transformed into PE. Stayed in Coma for 14 days and it only took 9 days for the doctors to figure it out. (Kinda sad ain't it). But I am happy to say that O2 returned to normal on the 13th day and even though doctors were certain of brain damage none occurred. He has had no lasting effects and has only a slight limp due to pins, screws and plates. 1.2 million in medical bills though.


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## firetender (May 20, 2011)

*How odd!*

First time  a thread like this got solved so quick...

...without 14 different opinions, 11 criticisms on everybody else's poor guesses, maybe a few off-topics and one or two temporary bans!

Not only that, but the first time the OP didn't egg everybody on to extend the thread (longer is better?), or throw in a McGuffin or two to send everyone on a wild goose chase.

I'm impressed!


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## IvanD (May 25, 2011)

For the non-educated but curious bunch, could you guys explain the mechanisms that lead to pulmonary embolism and bone marrow embolus?


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## JPINFV (May 25, 2011)

Emboli: Something free in the cardiovascular system that either does, or has the potential, to get stuck and block blood flow. 

Pulmonary embolism is a condition where something gets stuck (e.g. blood clots, fat, cholesterol, etc, but normally blood clots) in the capillaries of the lungs. Basically think ischemic stroke, but in the lungs instead of the brain. The lungs themselves are more common to catch an embolism since all blood has to go through the lungs (unless there's a septal wall defect like patent foramen ovale) and blood clots are more likely to form in the low pressure venous system.

A bone marrow emboli are exactly that. Bits of bone marrow floating around in the blood. These are commonly released by long bone fractures.


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## abckidsmom (May 25, 2011)

crazycajun said:


> You are both correct. The BME or FES transformed into PE. Stayed in Coma for 14 days and it only took 9 days for the doctors to figure it out. (Kinda sad ain't it). But I am happy to say that O2 returned to normal on the 13th day and even though doctors were certain of brain damage none occurred. He has had no lasting effects and has only a slight limp due to pins, screws and plates. 1.2 million in medical bills though.



When I worked in a Level I Trauma ICU, we got people in all the time from outside hospitals with stories like this of cluelessness.  I don't understand how a physician can let someone lay in a critical care unit for 9 days with this story and not know what was going on.  I am *certain* that BME got a mention in my 9 month paramedic class 12 years ago...how could an orthopedic surgeon miss something like this?


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## IvanD (May 25, 2011)

Is there a reason why embolisms appeared in the lungs and bone marrow instead of other places?


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## Aidey (May 25, 2011)

The embolism is made up of bone marrow, there isn't an embolism IN the bone marrow. And it showed up in the lungs because the lungs are generally the end of the line for the venous system, and they tend to catch anything floating around in it.


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## crazycajun (May 26, 2011)

abckidsmom said:


> When I worked in a Level I Trauma ICU, we got people in all the time from outside hospitals with stories like this of cluelessness.  I don't understand how a physician can let someone lay in a critical care unit for 9 days with this story and not know what was going on.  I am *certain* that BME got a mention in my 9 month paramedic class 12 years ago...how could an orthopedic surgeon miss something like this?



I argued that point for 8 days. I was told by each doctor that my diagnosis was incorrect and I should stick to EMS and worry about MVC's and such. On the ninth day I finally got my wish and had a pulmonary specialist brought in from Houston and he found the problem. As for the orthopedic surgeon. He showed up in my son's room a week after he got out of CICU. His first comment was "I thought you died".


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## rogersam5 (May 28, 2011)

crazycajun said:


> I argued that point for 8 days. I was told by each doctor that my diagnosis was incorrect and I should stick to EMS and worry about MVC's and such. On the ninth day I finally got my wish and had a pulmonary specialist brought in from Houston and he found the problem. As for the orthopedic surgeon. He showed up in my son's room a week after he got out of CICU. His first comment was "I thought you died".



Wow... thats all I can say about that...


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## mycrofft (May 29, 2011)

*Lungs are like a filter sort of*

If anything gets through the right atrium and out the right ventricle, it is headed for a huge bed of very fine blood vessels in the lungs. Block a portipn's circulation and it can't adequately do its job.

Experts, what about collateral circ in lungs? Embolus-caused infarcts?


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## jjesusfreak01 (May 29, 2011)

crazycajun said:


> You are both correct. The BME or FES transformed into PE. Stayed in Coma for 14 days and it only took 9 days for the doctors to figure it out. (Kinda sad ain't it). But I am happy to say that O2 returned to normal on the 13th day and even though doctors were certain of brain damage none occurred. He has had no lasting effects and has only a slight limp due to pins, screws and plates. 1.2 million in medical bills though.



Lets see, took the doctors 9 days, EMTLIFE had an answer in 9 minutes, the complete answer in 15...good job guys...


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## abckidsmom (May 29, 2011)

mycrofft said:


> If anything gets through the right atrium and out the right ventricle, it is headed for a huge bed of very fine blood vessels in the lungs. Block a portipn's circulation and it can't adequately do its job.
> 
> Experts, what about collateral circ in lungs? Embolus-caused infarcts?



I don't think I understand the question.  What are you asking about?  Pulmonary infarcts from PE?


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