Slumpy

[Smash]

Hmm, orders for what?

Orders for lunch off the menu of course! What other orders can there be?

 

[MrBrown]

Orders for lunch off the menu of course! What other orders can there be?

You never know, some people might start wandering from the program and getting crazy, calling up for orders to all sorts of stuff. Lasix springs to mind.

If anybody out there uses IV GTN would you consider a nitro drip (I was thinking for the edema but perhaps [also] for the hypertension?).

Oh and here is the specials board for today:

Seafood marinara cooked with chilli, garlic and lemon served with pasta
Genuine homemade cheeseburger and fries
Leek, potato and carrot soup served with bread
Fresh grilled chicken salad
Italian tomato and herb soup
BLAT (bacon, lettuce, avacado and tomato)

Brown does cook you know

 

[vquintessence]

You never know, some people might start wandering from the program and getting crazy, calling up for orders to all sorts of stuff. Lasix springs to mind.

If anybody out there uses IV GTN would you consider a nitro drip (I was thinking for the edema but perhaps [also] for the hypertension?).

Well without all them gizmo's and no more than two pairs of hands, I'd avoid the GTN like the plague.

A lot is presently pointing towards a popped brain (intracerebral hemmorhage). There was no sign of trauma, he's hypertensive, seized (no hx inferred from the med list found), blown pupil, acute AMS presumed (he WAS operating a vehicle until he had the foresight to pull on over). You said BGL was WNL?

Giving a vasodilator to deal with some rales & HTN seems a dangerous walk. The poor soul is already unresponsive, he shouldn't be too tough to ventilate; but lets watch for trismus and the likely emesis. IMHO, the ambu for this gentleman is truly for rapid transport after allowing for the assessment which yall have already discussed.


EDIT: I'll take a BLT with pickles and light mayo

 

[mycrofft]

Only one person suggested spinal immobilization?

Oh, the protocols, the poor disrespected protocols. He might have pulled over unobserved, opened the door, stood and banged his neck on the top of the door a few times at different angles, run arund the car three times and done jumping jacks, then slid back in, closed up, taken one look at the eatery's prices and stroked out.

Firetender and I are of a generation, as they say. Bedrock EMS!

 

[Veneficus]

You never know, some people might start wandering from the program and getting crazy, calling up for orders to all sorts of stuff. Lasix springs to mind.

Lasix for what? because of some rales? That is a little overzealous.

If anybody out there uses IV GTN would you consider a nitro drip (I was thinking for the edema but perhaps [also] for the hypertension?).

Not a chance. Until Neuro sees this guy he is getting supporting care.

Looking a little deeper, effexor raises BP. So when that starts to taper off (whenever that is), what will his BP drop to? (a little too much mad scientist mixing chemicals for me)

I would bet dollars to doughnuts this is a bleed. Even if you lower his BP it doesn't mean the bleeding will stop. With the blown pupil, it already looks like the increased bp is needed to maintain CPP. I would also bet the bleed somewhere in the anterior arteries with the rapid onset and presentation.

Based on his apparent GCS signs and rapid deterioration, this isn't a small artery bleeding. Wouldn't waste anymore time than absolutely required. With no apparent damage to the vehicle I wouldn't immobilize this guy.

The only thing worthy of calling in for is to have Neuro surg meet you at the door with some power tools. They will likely want a CT (they always do ABC, airway, breathing, ct)
Maybe they just want to see how great the shift is?

Oh and here is the specials board for today:

BLAT (bacon, lettuce, avacado and tomato)

Brown does cook you know

Never had it with avacado, that sounds worth trying. BLT with a healthy dose of guacamole.

Sounds like the patient is having whatever was on the farm he just bought and will be admitted to the vegetable garden or the ECU.

 

[mycrofft]

Get Mexican avacados unles your raise your own.

Not many folks as gone as this one come back. Hold his order.

 

[MrBrown]

This gentleman is now helping Ma tend to the garden unfortunately.

It seems the stroke caused a neurogenic edema and that in turn caused so much strain on his heart he had an infarct.

I was curious about GTN as its the mainstay of pulomary edema management through lowering preload, if this guy has reduced left ventricular compliance it would seem to marry up that reducing preload is a good thing. However that said, with hie neuro bleed it probably is not.