Stroke? Or what?

JPINFV said:
You're missing that I missed that the patient was in a-fib.
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It all makes sense now! I agree on liking to see some labs but with what we know now I'm with n7lxi and adamjh3 putting CVA at the top of my list of suspicion, hyperK does make sense too but no access to a 12lead pretty much ties your hand on that one.
 
adamjh3 said:
As far as sepsis, the patient would generally have a fever, yes? Sublingual temp was 98.3

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Fever is one diagnostic criteria for sepsis, but it isn't the only or a make or break criteria. This is especially true if there is any type of immunocompromise for any reason.
 
Hyponatremia? Though I didn't notice any seizure activity

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Do all cases of hyponatremia present with seizures?
 
JPINFV said:
Do all cases of hyponatremia present with seizures?
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Certainly not. Especially if it develops over a period of days rather than acutely... right?

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adamjh3 said:
Hyponatremia? Though I didn't notice any seizure activity

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Wouldn't hyponatremia show ecg changes such as ST elevation along with possibly bradycardia and hypotension presenting? Not enough sodium available for adequate depolarization or do I have it backwards? Again with no 12 lead but I would suspect a 3 lead, although non-diagnostic, would show elevation.
 
NVRob said:
Wouldn't hyponatremia show ecg changes such as ST elevation along with possibly bradycardia and hypotension presenting? Not enough sodium available for adequate depolarization or do I have it backwards? Again with no 12 lead but I would suspect a 3 lead, although non-diagnostic, would show elevation.
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I was thinking exactly the same thing. Hyponatremia will Probably present in ECG findings more likely than a seizure. Prolonged QT is one of the main findings for hyponatremia, whereas hypernatremia is a shortened QT.
 
There is a lot of information I would like to see, but from what is given I don't know that I agree this is a stroke. If the area of the stroke was large enough to affect consciousness then there should still be localizing symptoms. If he is unresponsive and flaccid it could be a stroke in the basilar artery, but the other major arteries would be unlikely. Same story with bleeds, if it's large enough to affect consciousness I would expect some other findings.

With the given information I'm leaning towards a more global process, metabolic or toxic. Just my 2 cents.
 
CVA or an electrolyte imbalance. Or demonic possession.

Without CT, 12 lead and labs we're all just tossing darts at the board.

Hey OP, how about some follow up?
 
n7lxi said:
CVA or an electrolyte imbalance. Or demonic possession.

Without CT, 12 lead and labs we're all just tossing darts at the board.

Hey OP, how about some follow up?
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Yeah, I shot an email off to my QA last night to see if I can't get some info from the hospital.

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n7lxi said:
Any updates?
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Not yet. The joys of BLS in SoCal. It'll be a while before I hear back from my company.

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Is there any way for me to get the information myself without dealing with the sluggish corporate BS of my company? Who would I talk to at the hospital? I'm completely ignorant when it comes to how QA/QI works

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adamjh3 said:
Is there any way for me to get the information myself without dealing with the sluggish corporate BS of my company? Who would I talk to at the hospital? I'm completely ignorant when it comes to how QA/QI works

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Theoretically you should be allowed access to his chart being as you were one of his providers. Ask the charge nurse about it. If it truly takes that long for corporate to get you a chart for QA/QI tell her that and if she/he has any sort of reasonableness to her she/he will help you out.
 
How often do you visit that specific ED? Maybe the nurse will remember you and that patient and be able to slip you some information.
 
Heard back from the sup that does QA/QI while I was driving to work this morning, he told me the hospital told him they don't have a pre-hospital care coordinator or anything like that, so to get info about the patient we'd have get a release from the family. I'll stop by the hospital today to see if I can't find anything out on my own.
 
adamjh3 said:
Heard back from the sup that does QA/QI while I was driving to work this morning, he told me the hospital told him they don't have a pre-hospital care coordinator or anything like that, so to get info about the patient we'd have get a release from the family. I'll stop by the hospital today to see if I can't find anything out on my own.
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Yup, the charge nurse told me the same thing when I went in today.

It was Sharp Memorial, if there's anyone locally in the know who knows someone I can talk to in there that might be able to help me out, please PM me. I want to know what happened with this guy.
 
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