32yr Male, "snoring, can't wake him up"

One blown pupil, GCS 6 pt, on warfarin, obtunded airway. Cushings triad is a late sign. Maybe he's no there yet. Maybe drugs are complicating it. You'd want your head read if you didn't assume he'd blown a head gasket and go from there.

Why no BGL?
Is this the only hx and physical info we're ganna get?

I figure this scenario is about misinterpretting some of these details like the old, his pupil wasn't blown it was from cataract surgery, oh his GCS wasn't actually 6, he was just deaf or whatever etc.
 
Actually im going with drugs....I know it said nothing to suggest drugs or alcohol so thats why im picking it
 
Other than not saying anything about drugs....why are you picking that?
 
truetiger said:
Other than not saying anything about drugs....why are you picking that?
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Although If it were my scene I would assume head bleed till proven otherwise, the vitals just dont scream bleed to me.

ETA: im sure im way off but its fun to play along and learn
 
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Are you waiting for Cushing's Triad before you call it a bleed?
 
truetiger said:
Are you waiting for Cushing's Triad before you call it a bleed?
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No it could certainly be very early stage, but this is a scenario, and I can have fun with it and say drugs on a whim and nobody dies because of it.
 
ohh ohh ohh, the warafin. these products prolong the PT primarily through the inhibition of the vitamin K coagulation factors. Commonly found in some rodenticides. (for killing little critters) they can present as asymptomatic but can develop bruising and the unequal pupils you saw.

Did you intubate him, if so was there any swelling of the esophageal lining because it also commonly causes internal GI hemmorage, which is why the rats die.

Or I could be totally off the subject and he could of been a really heavy sleeper.
 
Well, looks like most of you picked it long before my partner did at the time. She was sure it was drugs or trauma related, I kept on suggesting a head bleed, aaaaaaaannnndddd.......I was right. That bit wasn't hard to work out really. The tricky bit for me was why the hell did a 32 year old guy who looked fit and well stroking out? The MRI showed multiple, small, chronic subdural haematomas, and one big mother that had occurred recently, big enough to cause midline shift. The patients lupus required him to be on the warfarin, and obviously his cerebral arteries weren't handling the pressure all that well.

There was no blood gas because primarily we don't do them in the truck, and also I couldn't remember the results at the hospital. Sae to say he had metabolic acidosis. As I said before, we don't RSI so he got the NPA, lateral position, and a diesel bolus.

Last I heard the neurosurgeon was trying to contact the family to try and get permission to let him die, because otherwise he would have to intervene for zero chance of positive outcome. Sad, but there you go.
 
not-lupus.png


I was hoping for the deaf glass-eyed snorer option... :D
 
McGoo said:
Well, looks like most of you picked it long before my partner did at the time. She was sure it was drugs or trauma related, I kept on suggesting a head bleed, aaaaaaaannnndddd.......I was right. That bit wasn't hard to work out really. The tricky bit for me was why the hell did a 32 year old guy who looked fit and well stroking out? The MRI showed multiple, small, chronic subdural haematomas, and one big mother that had occurred recently, big enough to cause midline shift. The patients lupus required him to be on the warfarin, and obviously his cerebral arteries weren't handling the pressure all that well.

There was no blood gas because primarily we don't do them in the truck, and also I couldn't remember the results at the hospital. Sae to say he had metabolic acidosis. As I said before, we don't RSI so he got the NPA, lateral position, and a diesel bolus.

Last I heard the neurosurgeon was trying to contact the family to try and get permission to let him die, because otherwise he would have to intervene for zero chance of positive outcome. Sad, but there you go.
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I've had patients as young as 15 stroking out.
 
Sarcoidosis!
 
Snoring respirations is a general term, differentiating between stokes, kussmaul, and biots can also help, but with medications laying there for you the coumadin puts head bleed ay the top of my list.
 
clibb said:
I've had patients as young as 15 stroking out.
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Colleagues have treated patients as young as four stroking out, but it isn't the first thing that comes into my head when you have an altered conscious state in a healthy looking young adult.
 
McGoo said:
Colleagues have treated patients as young as four stroking out, but it isn't the first thing that comes into my head when you have an altered conscious state in a healthy looking young adult.
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One of the special needs children/frequent flyers in our district is 4 or 5 and has had multiple strokes
 
Don't let the age talk you out of it. Most things will not present like the book says they should.
 
clibb said:
I've had patients as young as 15 stroking out.
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We had a health 14yom Stroke out a few months back. Only health issue was that he was MILDLY obese... Less so than 90% of the children today -.-
 
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