Give me a differental, please...

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I guess they changed it. Every hosp I go to tell me that temporal is core now. I am with you Sasha about the rectal though. Do you have any suggestions about the call. What do you think it could be Sasha?
 
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emtfarva said:
It was dispatched as an emergency. And my partner thought that this was life threating. the hosp even booked it as a high priority and placed the Pt on a cardiac protocol.
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From what I have read the patient didn't seem to have any apparent life threats, her vitals were stable, she was febrile, possibly septic, ABC all intact, AAOx4 appropriate speech. Personally I don't see any indications for an emergent return. Granted none of us were there except you so perhaps there was something you medic saw that stuck out at him. Often hospitals will place emergent return patients at a high priority list regardless of CC.
 
Core is not a nebulous term that is up for interpretation. Just like Mt. Fuji cannot be at the core of the Earth, the head cannot be at the core of the body.

Well... actually... there is such a condition. And it is quite common in EMS personnel, lol. But generally speaking, the head is not found in one's rectum. :D
 
No, but this thread is not about treatment. It is about assessment, as is medicine in general. Without an accurate assessment, there is no treatment. And your hospital doesn't want to know simply if she is febrile or not. They want to know WHAT the temp is. You don't dumb your assessment down just because you lack the clinical sophistication to act upon it.
 
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sir.shocksalot said:
From what I have read the patient didn't seem to have any apparent life threats, her vitals were stable, she was febrile, possibly septic, ABC all intact, AAOx4 appropriate speech. Personally I don't see any indications for an emergent return. Granted none of us were there except you so perhaps there was something you medic saw that stuck out at him. Often hospitals will place emergent return patients at a high priority list regardless of CC.
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I think it was the violent tremors (forgot the adjective in the op) that had her concerned. Also the doc said something to her about Sepis I was working the Pt while my partner was getting the report from the doctor.
 
sir.shocksalot said:
From what I have read the patient didn't seem to have any apparent life threats, her vitals were stable, she was febrile, possibly septic,
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Sepsis and MS can be very life threatening. That is why I asked about last food intake. This patient may be intubated as soon as the lactate level is ran.

Saying her vitals are stable means you have been observing/trending them for some length of time and not just 5 - 15 minutes.

I probably would not have ran L/S to the hospital since a Paramedic should be able to handle airway and BP. If the Paramedic is in the back of a speeding ambulance with noisy sirens, his/her focus will be safety and not assessing the patient or effectively treating if the patient decompensates.
 
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I should read up on MS some, I'm not really familiar with the disease.
 
VentMedic said:
Sepsis and MS can be very life threatening. That is why I asked about last food intake. This patient may be intubated as soon as the lactate level is ran. Saying her vitals are stable means you have been observing/trending them for some length of time and not just 5 - 15 minutes.

I probably would not have ran L/S to the hospital since a Paramedic should be able to handle airway and BP. If the Paramedic is in the back of a speeding ambulance with noisy sirens, his/her focus will be safety and not assessing the patient or effectively treating if the patient decompensates.
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Vent, her airway was pantent and she was breathing at a normal rate and volume. Also the town we were in would have made transport non-emergent 3-4 times as long as we took running code. Now even if the Pt's airway was open would they still have tubed her? Please explain this for me.
 
VentMedic said:
At the ALS level, yes it can. One may start to think about how much fluid and the potential for pressor use to maintain BP.
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I won't argue that temperature isn't important, but the question is the route really relevant? The few degrees one reading will be off from another has little clinical significance, are we going to treat the thermometer or the symptoms? We as EMS professionals don't usually have the luxury of taking temperatures.
 
emtfarva said:
Vent, her airway was pantent and she was breathing at a normal rate and volume. Also the town we were in would have made transport non-emergent 3-4 times as long as we took running code. Now even if the Pt's airway was open would they still have tubed her? Please explain this for me.
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Breathing quality is not the only indication to intubate.

If she was seriously septic, yes. She has the potential to decompensate in terms of BP and may need fluid resuscitation. Also she may need a central line to monitor her SjvO2 which will be easier if she is intubated to maintain comfort and control tremors.
 
sir.shocksalot said:
I won't argue that temperature isn't important, but the question is the route really relevant? The few degrees one reading will be off from another has little clinical significance, are we going to treat the thermometer or the symptoms? We as EMS professionals don't usually have the luxury of taking temperatures.
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Temperatures taken further from the core may not reflect the true temp since the body is diverting its resource to the core in sepsis. The peripheral perfusion is diminished. The skin my feel cool and almost "normal" while the core is 104+.
 
sir.shocksalot said:
...the question is the route really relevant? The few degrees one reading will be off from another has little clinical significance,
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Incorrect. Read up on the temperature variations found in the different devices. It is more than a question of variation. The difference between one thermometer being used in different orifices is a question of simple variation that can be correlated. But when you use the temporal or tympanic thermometers, there is a serious question of overall accuracy to be considered. They can be off by a medically significant amount.

are we going to treat the thermometer or the symptoms?
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Again, temperature is part of a complete assessment. Before rendering any treatment, we should be performing a complete assessment to be sure of what we are actually treating. What you are talking about is simply treating symptoms. That is no better than treating the thermometer.

We as EMS professionals don't usually have the luxury of taking temperatures.
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Lecture us about what EMS professionals should do when you are one. The key term in EMS is MEDICAL. And medical professionals don't have the "luxury" of simply treating symptoms by the cookbook because they don't have the education or understanding to interpret the results of the assessment that they should be performing.

This is an example of why it is so much easier to make a good medic out of someone with no EMT experience. We don't have to waste time going back to wash all these silly notions of "we don't need all that book learnin' because I'm just an ambulance driver" out of their heads.
 
VentMedic said:
Breathing quality is not the only indication to intubate.

If she was seriously septic, yes. She has the potential to decompensate in terms of BP and may need fluid resuscitation. Also she may need a central line to monitor her SjvO2 which will be easier if she is intubated to maintain comfort and control tremors.
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Ok, thanks. I don't think that she was that septic yet if septic at all. Her bp was still good, right around normal range when we left the ER. I was more thinkin about the pain and the tremors. I know that heart problems can come from anything. I know alot of the info you want is not here and I am doing my best to answer your questions but do you think that this is an infection?
 
AJ Hidell said:
Fever + chills = infection until proven otherwise
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MS also effects body temp and regulation of body temp. A friend of mind with MS has a chroinc mild fv and chills in a house that is 80 degres.
 
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emtfarva said:
Ok, thanks. I don't think that she was that septic yet if septic at all. Her bp was still good, right around normal range when we left the ER. I was more thinkin about the pain and the tremors. I know that heart problems can come from anything. I know alot of the info you want is not here and I am doing my best to answer your questions but do you think that this is an infection?
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But, you also stated she already got one bolus of NS. That could explain the BP being "norm" now.

I didn't say anything about heart problems.

Fever
UTI (Urinary Tract Infection) - blood in urine - that is why I asked about antibiotics.
MS
Tremors

Pending septic work up wihich includes a lactate level. Depending on other lab finding will determine if they do a full sepsis protocol to anticipate complications.

MS also effects body temp and regulation of body temp.
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Look at the other symptoms.
 
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