usalsfyre's Train Wrecks #1

[silver]

for once, can someone woth flu like symptoms have the flu? I am just sayin!

or the patient could have a viral/bacterial infection that caused a carditis (peri, endo, myo), where the flu like symptoms preceded any cardiac issues. Something like endocarditis can cause AV block, ST elevations and inversions. Though I am not feeling any of those...

On the other hand an AMI seems too simple...

 

[usalsfyre]

Anybody still thinking CO toxicity?

 

[CANMAN]

Being a fireguy as well with a reading of 4ppm thats not super concerning BUT as a company officer I would have done a 360 of the home upon arrival. Could he have possibly opened the windows today, but they have been closed recently? In my jurisdiction we also have access to RAD57 so I would call for a unit with that and utilize that as well to rule in or out CO toxicity

 

[Shishkabob]

Anybody still thinking CO toxicity?

You said iStat... do you also have an LP15 with CO monitoring?

 

[usalsfyre]

You said iStat... do you also have an LP15 with CO monitoring?

Sure...it's zero. See Roguemedic's writings on the RAD57 to see how useful this is

 

[Shishkabob]

Sure...it's zero. See Roguemedic's writings on the RAD57 to see how useful this is

You also sad he was satting 90%, so I wasn't even leaning towards CO

 

[usalsfyre]

You convince him to let you transport him and the iStat results are...

Troponin is 0.8, CK-MB is 0.7, and I'll give you an extra, BNP is 325.

No open windows.

2L by NC bumped your sats to 95% and gives you a new number, ETCO2 is 32.

Hospital choices are a small community center 5 minutes away, a mid-sized center with a small ICU and a "diagnostic" cath lab 30 minutes away and an academic Level 1 with everything under the sun 90 minutes away. Your the only unit available for the area, back-up truck must respond from the next town over and will add about 15 minutes to the response. Where are you going and why? What do you want to do enroute? So far we've got a saline lock and 2lpm by NC

Before anyone ask, no HEMS, it's cloudy/foggy/down for maintenance/the football game is on.

 

[JPINFV]

For some strange reason I want to throw Lyme disease out there as well as hypothyroid.

 

[lawndartcatcher]

I vote for the cath lab. Continue assessment, full head-to-toe. Any weird / obvious bites / rashes / purpurae anywhere?

I'm not really familiar with Troponin, but I know that .08 is high (normal level ~.1, right?). I also know higher levels can be caused by CO poisoning, MI, sepsis, snake bites, etc. - all the stuff that's been proposed.

To this day I don't trust SPO2 meters. The guy from Masimo told us that any reading up to 5 is within standard deviation, more if your patient is a smoker. A zero reading says (to me) that this isn't a CO case.

I vote MI, too.

You convince him to let you transport him and the iStat results are...

Troponin is 0.8, CK-MB is 0.7, and I'll give you an extra, BNP is 325.

No open windows.

2L by NC bumped your sats to 95% and gives you a new number, ETCO2 is 32.

Hospital choices are a small community center 5 minutes away, a mid-sized center with a small ICU and a "diagnostic" cath lab 30 minutes away and an academic Level 1 with everything under the sun 90 minutes away. Your the only unit available for the area, back-up truck must respond from the next town over and will add about 15 minutes to the response. Where are you going and why? What do you want to do enroute? So far we've got a saline lock and 2lpm by NC

Before anyone ask, no HEMS, it's cloudy/foggy/down for maintenance/the football game is on.

 

[usalsfyre]

I vote for the cath lab.

Quick word on diagnostic cath labs. These are facilities that can't actually perform baloon angioplasty or place a stent. They can simply diagnose coronary occlusion. Back in the early 2000's they were all the rage, however their popularity has faded for obvious reasons. So if this guy gets in that cath lab and they discover a blockage, they will then have to transfer him out.

Continue assessment, full head-to-toe. Any weird / obvious bites / rashes / purpurae anywhere?

You notice a "bullsye" rash on the posterior aspect of his left shoulder. When asked about it, the patient says it's been there for a about a week.

I'm not really familiar with Troponin, but I know that .08 is high (normal level ~.1, right?). I also know higher levels can be caused by CO poisoning, MI, sepsis, snake bites, etc. - all the stuff that's been proposed.

Troponin can elevate for a myriad of things. Anyone know how long it generally satys elevated post MI?

To this day I don't trust SPO2 meters. The guy from Masimo told us that any reading up to 5 is within standard deviation, more if your patient is a smoker. A zero reading says (to me) that this isn't a CO case.

The "Rainbow" CO2oximeters have a number of doccumented problems.

I vote MI, too.

This case is drawing to a close, conclusion will be posted tommorow.

Sorry for the delay today, I'm on shift and we've been all over hell's half acre.

 

[Shishkabob]

You notice a "bullsye" rash on the posterior aspect of his left shoulder. When asked about it, the patient says it's been there for a about a week.

Lyme disease.

But jpin already said it, so he gets the credit

 

[phideux]

Lyme disease.

But jpin already said it, so he gets the credit

I beat him to it, I went the Lyme disease route the first day.-_-

 

[usalsfyre]

Lyme carditis it is folks. I'd stay away from the small facility but this patient doesn't need a cath lab, just IV antibiotics.

Scenario 2 goes up Monday, will involve trauma.

 

[usalsfyre]

I beat him to it, I went the Lyme disease route the first day.-_-

Yep phiduex picked up on it early. It's defintely a zebra, but something to be alert for, especially this time of year for our rural folks.

 

[systemet]

Awesome scenario.