Man down, blood in ear (fall-down therapy?)

[mycrofft]

Called to the home of a man in his sixties. His wife said he has complained of pain in his left ear for a couple days, which he addressed with leftover Vicodin from a prior dental extraction a year ago. Lately he has been dizzy at times, and tonight he got up from his sofa to vomit in the bathroom, and fell, hitting his head.
He is unconscious, responds to painful stim but not regaining consciousness. Has a "goose-egg" swelling on his left forehead. During exam, you find he has a small amount of bloody cloudy drainage from his left ear. BP 154/98, pulse 70/regular, resp 16 unlabored and clear to auscultation. Pupil exam: unresisted, PERL. Meds: atenolol 25 mg PO BID, HCTZ 25 mg po QD, Zantac 150mg po QHS. Pulse Ox 98%, fingerstick glucose 102.

After spinal precautions are taken you put him in the ambulance and start to the hospital. Three blocks from home he rouses and regains consciousness. You ask him how he's doing; he replies "Other than the pain in my forehead, much better, thanks! Can I get off this danged board?". Happily the hospital is nearby. As you finish cleaning your ambulance and getting it back in order, his wife drives by, stops, rolls down her window, and says thanks, they are going to send him home with her tonight.

What happened?

 

[firetender]

Inner ear infection. Dizzy. Fall down. Hit head. You were there!

 

[mycrofft]

Spoilsport!


Otoscope wold be nice for these sorts of deals, no?

 

[Veneficus]

Otoscope wold be nice for these sorts of deals, no?

Only if you knew what you were looking at.

I can't get paramedics to use a thermometer and that is a vital sign.

 

[MrBrown]

Only if you knew what you were looking at.

I can't get paramedics to use a thermometer and that is a vital sign.

Ear infection, got a bit of vetigo, fell down, hit head.

I could swear that in my Brady Paramedic book it says under "Detailed Physical Exam" to check the ears with an otoscope as well as 500 other useless techniques. Had a look now but I can't find the page.

 

[Smash]

A bit off topic, but...

I don't know what the scenario was, because I can't read it. Is there any reason for the courier new font mycrofft? When I use my iPhone your posts are essentially unreadable when compared to the standard font. I don't want to get at you, but I'd love to be able to read what you have to contribute.

 

[mycrofft]

My apologies Smash.

I gues.....

er, I mean I guess everyone else enjoys not being able to read my stuff.
I have a couple or three mild occular conditions which makes the serifed font easier for me to read...from decades of conditioning with typewriters.
Besides, as I alays say, you can make the darndest horseapple smell likke petunias with New Roman....

 

[mycrofft]

MrBrow, I find otoscopes useful mostly to rule out or reassure.

Calls for ringing in ears, moths or earwigs in ears, sudden deafness, head pain, vertigo, ear pain, and the light works fine for checking pupils or looking down a throat, up a nostril, etc.

 

[mycrofft]

Veneficus, I hear you.

Some folks think a temp is a waste of time, usually you have time to do one. I stopped because my organzation will not replace the broken or worn out probes, giving us temps of 65 degress whch some folks are religiously citing.h34r:

 

[MrBrown]

Some folks think a temp is a waste of time, usually you have time to do one. I stopped because my organzation will not replace the broken or worn out probes, giving us temps of 65 degress whch some folks are religiously citing.h34r:

I think a temperature is a good indicator; not all patients will require a temperature taken obviously but it's an often overlooked aspect of clinical decision making.

Medical patients who are "unwell" are good patients to take a temperature on especially those who you may be leaning to recommending non transport to.

Children are another good candidate for a prehospital temperature because they are less able to handle changes in temp than an adult. This may lean you to transport or referral when you would otherwise not consider it.

A patient with a low temperature is I think the best person to shove a thermometer in ther gob. Somebody who feels unwell and a bit chilled is often written off as the flu or a minor infection and left at home however low temperature is often a sign of poor cardiac output.

As a lesson learnt here, a crew were sent to a guy on an extreme diet who felt "unwell" but had no physiologic abnormalities in thier exam and when they spoke to his weight loss consultant she told the Ambulance Officers that feeling "unwell" was normal. They left him at home and he died of a massive PE. Turns out the crew had taken a temperature of 34.6°C but not acted upon it.

 

[mycrofft]

Temp and PE? News to me. That's why we read here.

Their protocols might call for a temp but only as grist for the ER mill, or to "cover themselves". What were they trained to do with that info?

 

[thatJeffguy]

Interesting scenario.

Could you please describe for me the cloudy-bloody discharge from the ear? What ithe significance of this specific presentaTion?

 

[dream*medic]

Did the dizziness begin with the onset of the ear pain or after? Because it sounds like a simple inner ear infection & the dizziness could easily be related to the Vicodin.

 

[Melclin]

I thought PEs often presented with a low grade fever, but I've never heard of a low temp, let alone that low. I woulda written it off as a thermometer malfunction.

 

[Akulahawk]

All I can say is: looks like he had a middle ear infection, took Vicodin for pain control, got dizzy because of the infection, fell down, gave himself a good Grade 2+/3 Concussion (at the minimum) and inertia from the fluid in his ear ruptured his tympanic membrane, releasing the pressure. I think he regained consciousness as a normal recovery from his CHI/Concussion.

 

[mycrofft]

Yeah mostly. As far as field stuff goes, it's done.

Beta blockers can make you subject to BP drops as you stand or after you Valsalva, too., being experienced as dizziness, sometimes tunnel vision, and rushong or roaring tinnitus.