# Bend over blind



## mycrofft (Nov 26, 2012)

Patient is female, 56 y/o, 5 ft 3 in, 140 lbs, smokes pack a day since teens, drinks alcohol moderately but more than three times a week. Hx multiple URI-like allergies with constant s/s and self Rxed with OTC's, htn controlled with meds (metoprolol), preg1/deliv1, no other applicable history. Home on sick leave for headache and a "bad cold", leans over to check how her cookies are baking in the stove, and has a sudden short-lived headache coupled with a loss of sight in one eye. 

After three weeks off work and many expensive and risky diagnostics, she is on the road to recovery and eventually makes a complete return. 

Ideas? 
PS: She was a Kaiser pt. (Just being catty).


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## mycrofft (Nov 26, 2012)

*Whatsamadda, stumped?*


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## EMT B (Nov 26, 2012)

was she dehydrated?


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## NYMedic828 (Nov 26, 2012)

Was it a tumor or cerebral ischemia?


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## EMT B (Nov 26, 2012)

heart rate?
bp?
resp?
spo2?
are her pupils Pearrl?
BGL?

:censored::censored::censored::censored:s and grins lets get a 4 lead as well. 


nausea? vomitting? SOB?


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## Anonymous (Nov 26, 2012)

TIA
Aneurysm
Occular migraine 
Sinusitis
Horton disease


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## bigbaldguy (Nov 26, 2012)

Retinal migraine?


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## Anonymous (Nov 26, 2012)

Forgot idiopathic increased ICP


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## bigbaldguy (Nov 26, 2012)

She wasn't holding a fork when she bent over was she cuz  I almost lost sight in one eye doing that once.


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## mycrofft (Nov 26, 2012)

*Anonymous winged it*

After working her up for TIA, CVA and brain tumor, someone got smart and did a Waters view then a sinus series. She had a very well encapsulated, longstanding abscess (not allergies) ; she bent over which induced a valsalva along with gravity, and it intruded through the intervening bone (weakened over the years) to press on the optic nerve on that side.

They knocked her out, threaded a scope up there, drained it and placed antibiotic beads, widened the sinus outlet for better everyday drainage, and put her on IV antibiotics and hospital obs, followed by a long course of antibiotics at home. 

This is according to the pt, my former work partner. She said they thought perhaps a facial injury in a MVA (1968 or so) may have had something to do with it initially.


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## bigbaldguy (Nov 26, 2012)

mycrofft said:


> After working her up for TIA, CVA and brain tumor, someone got smart and did a Waters view then a sinus series. She had a very well encapsulated, longstanding abscess (not allergies) ; she bent over which induced a valsalva along with gravity, and it intruded through the intervening bone (weakened over the years) to press on the optic nerve on that side.
> 
> They knocked her out, threaded a scope up there, drained it and placed antibiotic beads, widened the sinus outlet for better everyday drainage, and put her on IV antibiotics and hospital obs, followed by a long course of antibiotics at home.
> 
> This is according to the pt, my former work partner. She said they thought perhaps a facial injury in a MVA (1968 or so) may have had something to do with it initially.



Good one.


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## mycrofft (Nov 27, 2012)

Kaiser did an odd one with her. They placed a diagnostic catheter through her femoral, then sent her in an ambulance across town to undergo the arteriogram, where they also removed the catheter and sent he back again via ambulance. Guess a catheter placement costs more than two ambulance runs and a removal.


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## Akulahawk (Nov 27, 2012)

mycrofft said:


> Kaiser did an odd one with her. They placed a diagnostic catheter through her femoral, then sent her in an ambulance across town to undergo the arteriogram, where they also removed the catheter and sent he back again via ambulance. Guess a catheter placement costs more than two ambulance runs and a removal.


I'm not sure if Kaiser has the ability to do arteriograms yet at their South Sac facility yet... Last year they were looking to get their cath lab up and running "soon" but until they do/did, they have to send all those patients out via ambulance to another facility to have any procedures done that would require use of a cath lab.


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## mycrofft (Nov 27, 2012)

This was at their Cot&$#^ Way facility in about 1996.


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