Bloody 21 YO Male

[Aidey]

Since when were resps of 32 "normal"? I agree DKA doesn't fit overall, but it doesn't sound like you could rule it out only based on respirations.

 

[Handsome Robb]

Since when were resps of 32 "normal"? I agree DKA doesn't fit overall, but it doesn't sound like you could rule it out only based on respirations.

Sorry, normal was a poor descriptive word. Regular, rapid and deep would have been better.

I'm not attempting to rule out DKA on respirations alone, this patient didn't present as DKA to me or my partner but that may be my inexperience talking.

 

[RocketMedic]

Three questions:

1. What sort of door? Some of those things can be pretty thick, and the chances of TBI go way up if it's a stout object.

2. Although I think I would have tried the Zofram, from personal experience, your partner is right. Concussions (TBI) suck, and Zofram doesn't touch them.

3. Does mom/gma/pt know of any seizure history at all?

 

[Handsome Robb]

Three questions:

1. What sort of door? Some of those things can be pretty thick, and the chances of TBI go way up if it's a stout object.

2. Although I think I would have tried the Zofram, from personal experience, your partner is right. Concussions (TBI) suck, and Zofram doesn't touch them.

3. Does mom/gma/pt know of any seizure history at all?

1. It was a hinged door, not flimsy by any means but I think stout would be a stretch.

2. Gotcha

3. None was mentioned and we did ask as well. All said he was healthy with only the ADHD Hx.

 

[RocketMedic]

Perhaps an emotional disorder or psychomotor disorder? I had a soldier with Tourette's whose twitch was to stomp the ground repeatedly with his right foot...perhaps this guys was to headbang?

 

[Aidey]

Sorry, normal was a poor descriptive word. Regular, rapid and deep would have been better.

I'm not attempting to rule out DKA on respirations alone, this patient didn't present as DKA to me or my partner but that may be my inexperience talking.

My reply was actually aimed more towards mycroff, who pointed out DKA pts don't have normal resps. This pts resps weren't normal, so his wisdom doesn't quite apply.

 

[exodus]

My reply was actually aimed more towards mycroff, who pointed out DKA pts don't have normal resps. This pts resps weren't normal, so his wisdom doesn't quite apply.

Mycroftt was speaking on the

RR 32 unlabored and regular

part and not the rate. Rates abnormal but the mechanics are normal.

 

[Remeber343]

so his wisdom doesn't quite apply.

Aidey, have you even seen dka in a patient? There's more to dka then just rapid resps.

 

[mycrofft]

Resps

DKA cases I saw did not have accelerated rests, but deep and steady, almost labored, sort of like head injury ones I'd seen. They were "found down" cases so I suspect if they were incapable of that deep ventilation they'd have been coroner's cases..but we picked up for them, too. (Long time ago). Smelled like canned pears.

Doing basic sick call over twenty years I often saw patients with resps over twenty per minute because they did not breath deeply. I took resps while taking temp and pulse so the pt didn't see me counting their resps to avoid purple elephant syndrome.*



As in "Clear your mind, don't think about a purple elephant"...
(or the StayPuff Marshmallow Man..."thanks, Ray!".)

 

[Aidey]

Aidey, have you even seen dka in a patient? There's more to dka then just rapid resps.

No never, the ink is still wet on my cert.

/sarcasm

No kidding there is more to DKA then rapid respirations which is why I agreed that this case did not fit. My issue was the use of the word normal to describe the pts respirations when they were not. The pts breathing was non laborered and regular. Kussmaul's are regular too, so the regularity of the pts breathing really doesn't have much sway in whether the breathing is Kussmaul's or not.

In metabolic acidosis breathing can be fast and shallow. As the acidosis progresses respirations become deeper to further help compensate. So if the pt had mild DKA their respirations could be shallow or normal in depth.

So again, while I agree that it is highly unlikely that you will ever have a DKA pt of any severity with normal respirations, this pts respirations are not normal. In this case DKA(or another metabolic acidosis) can not be ruled out simply based on respirations.

 

[Handsome Robb]

Aidey, have you even seen dka in a patient? There's more to dka then just rapid resps.

Oh you just stirred the pot.... h34r:

Found out today pt had an epidural hematoma, underwent emergent surgery and has a good prognosis per the scary, scary neurologist.

Also tox screen was clean.

Still no word on what caused the fall, my vote is still with a seizure. Neurologist liked my reasoning I'll try to keep after the case and see what they uncover.

 

[mycrofft]

I still think he was taking his pants off and tripped.

The DKA's I found were not fresh, they may have already "blown past" the short and fast stage. Neither last more than a week afterwards nor ever went home.

 

[bigbaldguy]

And DKA will not have a normal respiration.

I was thinking along same lines. Guy is completely exhausted does a bit of sleep walking trips puts his head through a door. dazed he stumbles around in the front yard while losing a bit of blood and getting a nice good panic on. When I was 12 I fell out of a bunk bed onto a glass of water which broke and cut me pretty badly on my forehead. I climbed back into the top bunk without ever really waking up. Dad found me a few hours later and took me in for 18 stitches.

 

[Aidey]

A seizure is so much less embarrassing than tripping over your own pants though, lol.

I think both scenarios are equally plausible at this point. If he has seizures in the future it will probably be assumed that is what happened.

 

[Handsome Robb]

A seizure is so much less embarrassing than tripping over your own pants though, lol.

I think both scenarios are equally plausible at this point. If he has seizures in the future it will probably be assumed that is what happened.

I vote we lock him in a room and bombard him with multicolored strobe lights and annoying sounds and see what happens h34r:

Yea...he might not like that.

I bet if he did trip over his pants and he knows it, that's one he will take to the grave with him. Hell he almost did anyways! Grandma saves the day!

 

[mycrofft]

bigbaldguy attempts highdive in his sleep, film at eleven.
Yeah, we'll buy that story for a dollar.