Foaming At The Mouth

Almost sounds like a CVA/brain bleed to me. Not unheard of in a 16 year old.
 
You know @DesertMedic66 is desperate when he texts you asking for the answer. Better not spill the beans Desert!
 
Summit said:
Tetnus shot? Kernigs and bridninskis signs?
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For lack of a better word the patient's neck could be called floppy and was easy to manipulate in all fields. Did not really manipulate her legs, though they were straight and rigid with decorticating feet.
 
My diagnosis is intracerebral bleed until proven otherwise.

I see nothing to indicate seizure, ischaemic stroke, meningitis, meningococcal septicaemia, traumatic brain injury or poisoning which are on my differential list.

Treatment? Well, regardless of cause, from the pre-hospital perspective it's fairly straightforward:

1. Suction airway, attempt NPA, if unsuccessful, jaw thrust and reservoir mask oxygen
2. Call for RSI Officer

I would go directly to a major hospital unless her airway was unmanageable and no RSI Officer was available, or it was quicker to perform an intermediate stop to get her airway managed then continue, although in practical reality it is probably going to be faster to meet RSI Officer en-route
 
DesertMedic66 said:
Almost sounds like a CVA/brain bleed to me. Not unheard of in a 16 year old.
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It just doesn't feel like an ICH although blowing an AVM seems like a decent cause. Presentation is just not quite right...

Wish I had labs.
 
Not going to hazard a guess, but why is it that apparently no one uses Endotrols for nasal intubation these days?
 
MrJones said:
Not going to hazard a guess, but why is it that apparently no one uses Endotrols for nasal intubation these days?
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Use them all the time. Most smaller services won't carry them, due to cost.
 
Coming to this late...

Meningitis/encephalitis
CVA
Status seizure
Drugs/toxic ingestion

But I'm sure it's going to be some other zebra.
 
reaper said:
Use them all the time. Most smaller services won't carry them, due to cost.
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We still have them. It's been forever since I even thought about nasaly intubating someone though. That's a low frequency procedure that I'm not nearly comfortable enough with.
 
Sounds laik that hydrophoby to me.

Which would be rather sudden onset, but it's in my differential diagnoses. Any recent animal contact?
 
reaper said:
Use them all the time. Most smaller services won't carry them, due to cost.
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We carry them, but no one uses them. If I'm at the point of wanting to intubate a conscious and breathing patient, I'd much rather do a standard RSI. My medical director hates nasal intubations, and I have never done one and am completely uncomfortable with the procedure.
 
Seirende said:
Sounds laik that hydrophoby to me.

Which would be rather sudden onset, but it's in my differential diagnoses. Any recent animal contact?
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I'll buy it, but I've never seen a case myself so I fear I'm buying it in the same way non-altitude folks would buy HACE. But it is a fair question.

Also, who even calls it that anymore? Rabies!
 
reaper said:
Use them all the time. Most smaller services won't carry them, due to cost.
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We actually do carry them so that the non-RSI qualified folks will have an option. That said, when I start working as a medic (non-RSI), I think I would rather just call for someone to come and do an RSI for me, be that by air or ground.
 
In any case, we elected to transport the patient to the pediatric facility. Enroute the patient was RSIed without difficulty and and an OG tube placed, with nothing of note suctioned with that. The patient was sedated with Fentanyl and Versed with minimal changes in vital signs.

She was quickly taken to CT, which was completely clear. After that she was admitted to the PICU and eventually they got around to drawing blood gasses, which apparently were not particularly abnormal. CO-oximety was then used and some very high (they didn't pass along numbers) values were found. The hospital called us, we called fire, they went out and their meter pegged at 1500ppm as soon as they walked into the house.

No one in the house ever had any symptoms since they were all staying upstairs (patient had the only ground floor bedroom). It's still unclear to me how my partner and I did not develop symptoms given those levels, perhaps levels were lower in the bedroom itself.

As for whether we use CO-oximetry ourselves: The LP15s were placed in service last winter with zero in service training on them aside from "it's got a color screen, everything else is the same as a 12." I asked if we had ordered them with spCO, which the supervisors and supply guy answered with either "no, too expensive" or "I don't know." In any case, every now and again the spO2 would switch to CO when someone had a reading over 10. How could this be if the monitors don't have them I asked???

"Well it probably doesn't work," was the answer. Oh it worked on this call alright. Values of 35 to 38 pre RSI. But as I had been told to discount it, we ignored it (my partner had no idea such a feature even existed on LPs). My supervisor then proceeded to ask us why I "blew off that reading since it made sense." It made absolutely no sense given presentation and environment and he was not aware that the monitors could that either. :mad:

I like where I work, but the lack of in service training has always irked me, and yesterday that was reaffirmed. It would not have changed much except that she probably would have ended up in the hyperbaric chamber quicker.
 
Ah... so that is why you needed hyperbarics!
 
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