Not so quick quiz....

[DT4EMS]

This was one of my actual calls about 13 years ago.....

You are dispatched to a report of "man with blisters on his arm that are bursting".

You arrive at the residence to find a 60ish male lying in bed. He is awake, alert and oriented to person, place and time.

He denies contact with chemical, thermal, or radiation source of heat. He also denies any recent bites or stings.

He is a very poor historian as are family members (that makes you nervous). He is fully clothed in bed, with covers on and you notice dirt around on the sheets.

His right arm has what appears to be 2nd degree burns from the wrist to the elbow. Some of the blisters have in fact burst.

The rest of the secondary is unremarkable. V/S also appear stable.

What do you think? How do you treat and at what level?

 

[Guardian]

really bad cellulitis, that seems to easy. How about bullous pemphigoid or maybe the rare pemphigus vulgaris.

 

[Guardian]

How would i treat it? I would get this person to a hospital stat! IV would be good. EKG would be good (i think EKG is a little cooler than ECG). Maybe a little O2.

 

[Jon]

If the "poor historian" part is making you nervous - I dunno.. I'd call Medical Command, explain the situation. I'd also call my supervisor, give them the 10-second story, ask that they come and give me a hand. I'd also get the medics there yesterday. I'd probably call the ED for Medical Command and explain the situation. Another thing I might try - around here I can call the fireboard and get connected to a Hazmat Chief Officer 24/7. I might try that, explain the situation to him and get his ideas...

In "current times" if he has no idea how he got it, we've got to treat it as a Chem/Bio agent and protect the public accordingly. This also means that we, along with the family, are contaminated, too. No tripsheet for this one for me

13 years ago (1993) Chem/Bio weapons weren't as big a threat. I'd be less quick to jump to that conclusion, but I'd still get ALS, and check with Medical Command.

 

[ffemt8978]

Given the fact that the entire family is poor historians and everything you described, my gut feeling is:

1) A case of adult abuse/DV - Get law involved.
-or-
2) A chemical exposure they don't want you to know about (maybe even leading to a crop they don't want you to know about) - Get law involved

 

[DT4EMS]

Here is a little more....

The man denies a chief complaint. The family stated they found him in be like this.

The an/patient is very cooperative with the exception of the poos historian. Everyone is actually friendly.

Remember you have a patient that appears in NO DISTRESS. He can't give you a reason behind the blisters. He just said he "woke up an' dare dey was". He denies any pain with them.



I will tell you this..... AN hour after transport I got a call from our medical director. The dude coded in the ER and was shocked numerous times without conversion. He subsequently died.


Doc asked "What do you think you had"? (Doc wasn'' sure until blood work came back)

 

[disassociative]

..

Has this man taken any antibiotics lately?

 

[joemt]

Any chance he was a sleepwalker? or... a Meth Producer? What was the rest of the house like... Could he have slept walked out to the "toolshed" where there might have been some type of organophosphate... ??

 

[DT4EMS]

What we later found out was gaseous gangrene. The patient was a chronic alcoholic. He aparently passed out some time before coming home in a yard or field.

What the MD suspected was he must have slept on his arm in such a way to hinder circulation.

When the MD called the base and told me the guy was dead I couldn't believe it. I had never heard of gangrene doing anything like that.

I can tell you I never forgot it.

Aparently the guys white count was off the chart even though he didn't feel like he had an elevated temp.

 

[Guardian]

What we later found out was gaseous gangrene. The patient was a chronic alcoholic. He aparently passed out some time before coming home in a yard or field.

What the MD suspected was he must have slept on his arm in such a way to hinder circulation.

When the MD called the base and told me the guy was dead I couldn't believe it. I had never heard of gangrene doing anything like that.

I can tell you I never forgot it.

Aparently the guys white count was off the chart even though he didn't feel like he had an elevated temp.

Wow!, thanks for sharing, I've certainly never heard of "gaseous gangrene" like that before.