What was that???

T

trauma1534

Forum Captain
Messages
309
Reaction score
3
Points
0
Hello people! I ran into yet another strange event this weekend on a call. I want your ideas on what it could have been. The ER was floored and had no idea what was going on with him.

I recieved a call to a 27 year old male patient with severe abd pain, migrane-like headache with pain radiating down his spine.

UOA, his wife met us outside, reporting that she came in a found him just laying on the couch not responding much at all. He had just been taken to the ER the Wed. before this for the exact same thing, was admited and had been discharged 2 days ago. At the ER Wed, they did a spinal tap to check for Miningitis, it was negative.

When I approached this patient, I found him laying in fetal position on couch, very lethargic. He was moaning and not able to answere me much at all. No PMHx, other than childhood spinal miningitis.

Signs/symptoms - lethargic, skin: cool, dry, pale, PERL
Alergies: nkda
m: vikodin (spelling???)
p: childhood spinal miningitis
l: water, that morning and the day before, very very little bits of food that morning
e: unknown

Patient denies any drug use other than 1 Rx vikodine that morning. Denies ETOH, no signs of it on board.

Patient was placed on 02 and loaded into truck. In the truck, his eyes rolled back and he was out of it for aprox. 3 min, still maintaining his 02 sats at 97%, and resp rate. Vitals: B/P 130/88, HR:64, Resp: 20

Patient did start shivering, I covered him with more blankets.

IV established, normal saline @ KVO. Patient was responsive by painfull stimuli.

Any ideas?
 
I would have to see lab results. I would be guessing in the dark by attempting to narrow this down if they already performed an LP, which means they already did a CT. (or at least one should always before an LP). He might have viral meningitis, which is not always detectable on a LP. But, usually your blood work will detect it. As well, they should had performed blood cultures and a full SMACK panel on him.

This could be a joo-joo sign of multiple illnesses from pancreatitis, to M.S. to Lymphomas or could be nothing at all... The head ache could be simply associated to dehydration, or the two may not be associated at all.

Which hurt the worse.. the abdominal pain or the head ache, and which appeared first? Recent trauma ? Was their symptomalogy of neuro such Kernigs signs, nuero deficits ? Abdominal pain.. where at specifically epigastric, hypochondriac regions, lower quadrants.. type of pain (sharp, colicky, cramping ?) a change in bowel or bladder habits, vomiting, ? Abdomen is it soft, palpable, any masses, or bowel sounds present (type of bowel sounds?)

Like I said there are a multitude of differential diagnosis, and without specific diagnostics, very little we can attempt to rule out in the field setting.

Of course treatment in the field is routine management of patient, what was his glucose level ?

R/r 911
 
Ridryder911 said:
I would have to see lab results. I would be guessing in the dark by attempting to narrow this down if they already performed an LP, which means they already did a CT. (or at least one should always before an LP). He might have viral meningitis, which is not always detectable on a LP. But, usually your blood work will detect it. As well, they should had performed blood cultures and a full SMACK panel on him.

This could be a joo-joo sign of multiple illnesses from pancreatitis, to M.S. to Lymphomas or could be nothing at all... The head ache could be simply associated to dehydration, or the two may not be associated at all.

Which hurt the worse.. the abdominal pain or the head ache, and which appeared first? Recent trauma ? Was their symptomalogy of neuro such Kernigs signs, nuero deficits ? Abdominal pain.. where at specifically epigastric, hypochondriac regions, lower quadrants.. type of pain (sharp, colicky, cramping ?) a change in bowel or bladder habits, vomiting, ? Abdomen is it soft, palpable, any masses, or bowel sounds present (type of bowel sounds?)

Like I said there are a multitude of differential diagnosis, and without specific diagnostics, very little we can attempt to rule out in the field setting.

Of course treatment in the field is routine management of patient, what was his glucose level ?

R/r 911
Click to expand...

I don't know which hurt the worst. He was unable to communicate with me to that extent. Initially there was pain and tenderness to the touch in the middle abdominal area. There were no masses noted, don't listen to bowel sounds. Blood glucose level was 85. It was a puzzle to the ER. They had him the previous week, and he was admited. Same symptoms. The wife said that the doctor said something about it being some sort of virus of a new strand. She couldn't recall what it was exaclty.
 
Most people "blow-off" viral syndromes, not realizing they are very often fatal and usually are very painful.

Albeit, medicine is getting better on treating and have at least started treated with virology and the illnesses. The usual treatment is usually supportive only. Antibiotics are usually not effective and does not work on viral syndromes, and as well complex things to diagnose. In fact most physician will look at the WBC and determine from there if it is probably viral or bacterial. The shift to left or right may ease the determination of viral or bacterial. Usually, if all else fails it will be diagnosed as a.... "virus"..

I would not be surprised that they admitted to "rule out" or to "observe" to be sure which way his symptoms lead to.

Again, I have seen many of these "no big deals" turn into early symptoms of catastrophic illnesses.

Interesting case....

R/r 911
 
We had a pt with exact symptoms. Turned out to be an aortic aneurysm.
 
The Head Ache most likely is from the LP. When I had meningitis the LP was the worst part. I had severe head aches for about 2 weeks after.
 
Very true LP can routinely give a head ache due to the absence of CSF or loss of some of CSF. That is why fluid re-hydration therapy is attempted, then analgesics, then if all is failed a "blood patch". Has anyone else seen a blood patch performed?

It is basically accomplished simply by redoing an LP and then establishing an IV simultaneously. After the LP is started, one draws up about 10ml of blood thorough the IV site, then the physician puts the blood into the LP. This usually causes the headache to dissolve if it is truly related to the LP.

R/r 911
 
Last edited by a moderator:
Ridryder911 said:
Very true LP can routinely give a head ache due to the absence of CSF or loss of some of CSF. That is why fluid re-hydration therapy is attempted, then analgesics, then if all is failed a "blood patch". Has anyone else seen a blood patch performed?

It is basically accomplished simply by redoing an LP and then establishing an IV simultaneously. After the LP is started, one draws up about 10ml of blood thorough the IV site, then the physician puts the blood into the LP. This usually causes the headache to dissolve if it is truly related to the LP.

R/r 911
Click to expand...

That's a new one on me. It makes a bunch of sense though. Thanks for sharing Rid!
 
Ridryder911 said:
Very true LP can routinely give a head ache due to the absence of CSF or loss of some of CSF. That is why fluid re-hydration therapy is attempted, then analgesics, then if all is failed a "blood patch". Has anyone else seen a blood patch performed?

It is basically accomplished simply by redoing an LP and then establishing an IV simultaneously. After the LP is started, one draws up about 10ml of blood thorough the IV site, then the physician puts the blood into the LP. This usually causes the headache to dissolve if it is truly related to the LP.

R/r 911
Click to expand...

I wish the Dr.s at Duke would have known that when I had mine. My head hurt for 2 weeks. As long as I was lying down with traction on my neck My head did not hurt but as soon as I sat up or tried to walk it hurt like He He.
 
Drug Mule. Package of Heroine he swallowed is ruptured. And Brian, that LP is not what makes that head hurt..
 
prizonmedik said:
Drug Mule. Package of Heroine he swallowed is ruptured. And Brian, that LP is not what makes that head hurt..
Click to expand...

Yeah, with a head like that, if it didn't hurt I would think something was wrong.
 
prizonmedik said:
Drug Mule. Package of Heroine he swallowed is ruptured. And Brian, that LP is not what makes that head hurt..
Click to expand...

no its working OT at the LSCI
 
You must log in or register to reply here.
Back
Top