# "Sick Person"



## thegreypilgrim (Sep 18, 2009)

Alright nothing too crazy here guys - in fact it's fairly basic - I just want some input here to see if I was on the right track. I had this call as a medic intern.

Dispatch time: 0045

MDC reads: 42 y/o male. 123 Main St. Anytown 12345 c/c "Sick Person"

Arrive on scene to find a 42 year old male, well-nourished, slightly overweight (about 190 lbs. at about 5'8") laying on the bed. No family or friends on scene. BLS crew beat you on scene and opted not to cancel you.

Patient is alert & oriented complains only of sudden onset of severe nausea/vomiting and dizziness. States he has vomited 4 times already in a space of about 2 hours. Has been feeling "sick" for the past 3 days with just general malaise and feels like his "ears are plugged" but no fever. Today symptoms are markedly worse as he now claims he cannot stand up without feeling intensely nauseous and dizzy. Also states something similar has happened to him in the past, went to PCP for it but can't really remember what the Dx was...something to do with eustachian tubes. 

Patient denies chest pain, dyspnea/shortness of breath, weakness, abdominal pain. No JVD or pedal edema. Patient has good CSM x 4 equal grips/pushes, no slurred speech, no facial asymmetry, no difficulty swallowing. No hematemesis, no hematuria, no melena/hematochezia, overall normal bowel movements. No pulsatile masses in abdomen.

Vitals are as follows:

BP - 130/86
P - 92
RR - 20 (unlabored and non-adventitious) 
SpO2 - 98% (room air)
ECG - NSR no ectopy (sorry guys I don't have a copy)
Skins - pale, cool, & diaphoretic
Pupils - ERRL and consensual 

History - Hyperlipidemia, GERD
Allergies - NKDA
Medications - Lipitor, Omeprazole, OTC antacids (Tums)

So, there it is. What are your thoughts as to the etiology of his symptoms and how you'd treat it. Just want to see how my thoughts match up to your guys'. Thanks.


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## Akulahawk (Sep 18, 2009)

I've got a couple things in mind...

I'd want to know more info about the N/V and Dizziness... (one before the other) and whether it's positional or not....
And I'd want a 12-lead...

and go from there.


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## thegreypilgrim (Sep 18, 2009)

Akulahawk said:


> I've got a couple things in mind...
> 
> I'd want to know more info about the N/V and Dizziness... (one before the other) and whether it's positional or not....
> And I'd want a 12-lead...
> ...


From what I remember the nausea came before the dizziness...and vomiting followed from that. Patient experienced mild relief while lying supine or on side - as I said earlier standing up produced a marked increase in dizziness (and hence N/V)

12-lead is unremarkable, just plain old NSR.


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## Akulahawk (Sep 18, 2009)

thegreypilgrim said:


> From what I remember the nausea came before the dizziness...and vomiting followed from that. Patient experienced mild relief while lying supine or on side - as I said earlier standing up produced a marked increase in dizziness (and hence N/V)
> 
> 12-lead is unremarkable, just plain old NSR.


Dizziness or vertigo?


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## thegreypilgrim (Sep 18, 2009)

Akulahawk said:


> Dizziness or vertigo?



Haha, vertigo.


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## Akulahawk (Sep 18, 2009)

If the patient wants transport... sure.

I'd do supportive care, have the patient minimize any head movement. 

If allowed by protocol, and the patient is still severely nauseated, give an anti-nauseant...

For starters. Could be an infection, BPPV, Meniere's..

however, I'd do supportive care... and transport nicely to the ED for evaluation as pt requests...


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## thegreypilgrim (Sep 19, 2009)

Akulahawk said:


> For starters. Could be an infection, BPPV, Meniere's..


Cool, this is the road I was headed down.



> If allowed by protocol, and the patient is still severely nauseated, give an anti-nauseant...


Unfortunately I didn't have antiemetics in my protocols; but, if I did I would've like to have given some zofran or something.


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## Akulahawk (Sep 19, 2009)

The reason why I'd have wanted to do a 12-lead, is that N/V with Dizziness might be a sign of a relatively silent MI... Just working out the differentials... to the best of my ability to treat.

Beyond that, I'd maintain a high index of suspicion... and closely watch the patient.


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