# Im pretty stumped.



## Ryanpfd (Apr 1, 2009)

ok so first off we all know that EMT-B's cant actually diagnos a pt
Ok so I was the gym earlier. My buddy is a life guard at the pool. we where sitting in the office when we noticed a male acting wierd. my friend asked him to stop doign what he was doing and he complied with out a problem. later we noticed that he was sitting weird on the bleachers. I left and contindued with my work out. ten minutes later i was called into the pool area from my buddy to find the same 17 year old male. lying supine on the ground. a "nurse" came over and started helping. We called 911. my buddy grabed c spine after I asked if thier was any pain in his neck and back, and he said yes. He was on one med. for a learning disability. alter and orianted x1 out of 4.(event). he didnt know his name place or time of day. blood sugar was 97. breathing slightly laybored at approximitly 20 pm.HR was 130. pupils PEARL. but said the neon lights where hurting his eyes. his left arm was slightly shaking but it seemed to be more or less nerves. his feet where blue and complained of pain a 7 out of 10. CSM's where good. what was this? could it just be a case of syncope? the nurse said sizure because of the arm twitching. Im not really convinced on either. let me know your input.ohh and btw Sorry Im a Medic student not a spelling teacher :glare:


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## emtfarva (Apr 1, 2009)

Ryanpfd said:


> ok so first off we all know that EMT-B's cant actually diagnos a pt
> Ok so I was the gym earlier. My buddy is a life guard at the pool. we where sitting in the office when we noticed a male acting wierd. my friend asked him to stop doign what he was doing and he complied with out a problem. later we noticed that he was sitting weird on the bleachers. I left and contindued with my work out. ten minutes later i was called into the pool area from my buddy to find the same 17 year old male. lying supine on the ground. a "nurse" came over and started helping. We called 911. my buddy grabed c spine after I asked if thier was any pain in his neck and back, and he said yes. He was on one med. for a learning disability. alter and orianted x1 out of 4.(event). he didnt know his name place or time of day. blood sugar was 97. breathing slightly laybored at approximitly 20 pm.HR was 130. pupils PEARL. but said the neon lights where hurting his eyes. his left arm was slightly shaking but it seemed to be more or less nerves. his feet where blue and complained of pain a 7 out of 10. CSM's where good. what was this? could it just be a case of syncope? the nurse said sizure because of the arm twitching. Im not really convinced on either. let me know your input.ohh and btw Sorry Im a Medic student not a spelling teacher :glare:


my guess would be CVA or SZ. But I am only a Basic.


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## emtfarva (Apr 1, 2009)

what was the rest of his VS? how did you get a chemBG?


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## 8jimi8 (Apr 1, 2009)

Sounds like a seizure to me. What was his response when you checked his orientation ( i mean quote him)?  How long before he could remember his name and where he was?  Were you able to get a history out of him at all?  What was he doing that was weird when y'all first told him to chill out?  Were there really neon lights by the pool, or did he just "think" there were neon lights? What medication was he taking?

you left out quite a bit of info.


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## Sasha (Apr 2, 2009)

It could be a number of different things. Thrombus, seizure, what have you, and no one is going to be able to diagnose this for you.


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## Ryanpfd (Apr 2, 2009)

emtfarva said:


> what was the rest of his VS? how did you get a chemBG?



resp. 20
pulse 130
sp02  98
Pearl good.(Im a nerd. I had a pen light in my bag.
alert but not oriented
skin/color/temp/condition was. Thier ;]/pale. cool/moist but he had just gotten out of the pool.
No lung sounds
No bp done by me nor heard
I saw the glucometer's results from the EMS on scene while giving PT info to one medic. 

other parts of sample history
one med. non narc. 
no known allergies.
last oral intake befor he went to the gym.


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## curt (Apr 2, 2009)

Well, it seems consistent with the postictal phase of a TC seizure. If he fell over into tonic phase, that's probably why his neck and back were hurting. The general seizure timeframe seems to work pretty good with you being away for ten minutes, too, with him being freshly out of clonic and into postictal. 

 Generally speaking, 17's too young for a CVA (BUUUUT medicine is nothing if not a system of 'usually'). 

 Still, it's hard to say for sure. You said his feet were cyanotic?


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## mycrofft (Apr 2, 2009)

*Postictal is not alert.*

Arm was twitching how? 
Strong smell of Munchausen without much more detailed description,.h34r:


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## Sasha (Apr 2, 2009)

mycrofft said:


> Arm was twitching how?
> Strong smell of Munchausen without much more detailed description,.h34r:



Psychologist Croft, eh?


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## mycrofft (Apr 2, 2009)

*I carry ammonia salts in my quickdraw holster.*

Little Sasha-Hopper, heed the great Gregory House well...."People Lie".
This one was lying on his back.


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## medicp94dao (Apr 2, 2009)

Sounds like a tonic-clonic seizure, the weird behavior could of been a preceeding symptom....... And yes people do LIE!!!!!!!!!!!!!!!


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## VentMedic (Apr 2, 2009)

Ryanpfd said:


> resp. 20
> pulse 130
> sp02 98
> Pearl good.(Im a nerd. I had a pen light in my bag.
> ...


 
This is not enough information to even do a good "basic" guessing game.



> alter and orianted x1 out of 4.(event)


Neuro status with physical assessement
Grip strength?
movement?



> his left arm was slightly shaking but it* seemed to be more or less ner*ves.


 
???


Did the movement stop when you touched the arm? 

No BP?

No lung sounds?


If you are a Paramedic student, review assessment and get yourself organized. Yes, I know you are a bystander here but you should know how to give a report to others about a patient before you ask people to just guess a diagnosis. Guessing without a basis is poor medicine. Everyone of us could guess but may not even be in the same ballpark due to lack of information from a good assessment. Thus, you learn nothing because our conclusions may be meaningless as it pertains to this patient.

Professional healthcare providers need to think in terms of how to make a working diagnosis from a thorough assessment for the differential factors and not just guess with a "sounds like". This is were some lose credibility in the ED because they can not back up how they came up with a treatment plan. They took a guess and ran with a protocol. Then, they get defensive if a doctor or nurse guestions why something was done.


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## mycrofft (Apr 2, 2009)

*No BP , no lung sounds...there's your DX*

Play taps.


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## BossyCow (Apr 3, 2009)

Define 'weird' you said he was acting 'weird' and was sitting 'weird'


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