Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 In an otherwise healthy male, maybe nowhere. Sounds like traveler's diarrhea. His pulse is a little fast secondary to fluid loss. What's his BP? He could easily be rehydrated with oral fluids, but there's little down side to tanking him up with a 1000-2000 cc's of fluid and sending him back to work the next day. A worker who is preoccupied with making it to the bathroom all the time is an unsafe worker, so the rest of the day off wouldn't be unreasonable. Low grade fever of 38.2 is noted. I wouldn't treat him with antibiotic therapy unless you have continued fever and diarrhea past the 24-48 hour mark. If things persist past that mark, either put his stool under the microscope or send it off for the same. A little phenergan mixed in with the IVF would help with the emesis and stomach pain. No need to evacuate back to mainland. Kristian Reninger RN, BSN, CEN, NREMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 >Oral rehydration of electrolytes (unless you need a bit of cannulation >practice- 16 guage iv cannula and >Saline solution at .k.v.o. rate) over 4 >four hour @ period 1.5 litres per hour >A shot of maxillon i.m.-dose obviously dependant on body weight. >Pulse oxometer in situ to view true oxygen stats for base line obs >BP for base line obs.If all good... Send the little squeezer back to work.. >youre caring Paramedic Mark. >From: " GARETH THOMAS " Reply- To: > Subject: Scenario >Date: Mon, 22 Sep 2003 16:46:47 +0000 > >OK guys this is my first attempt at writing a scenario so be gentle with >me..... > >You are spending a constructive if boring afternoon preparing the flight >lists in the installations clinic, somewhere off the coast of west africa. >The drilling program keeps changing so your lists are no sooner completed >than you have to start them all over again! To top matters off it is again >raining heavily and you have to go outside shortly to do the T cards and >lifeboat lists. > >You are interrupted by the appearance of one of the ex pat new-starts on >board. He is looking rather pale and is complaining of having " gastric Flu " >Which he blames on the barbeques that he had whilst undergoing his >induction at the shore base. > >He complains of feeling " achy " like when he had the flu last year. > >On examination you note that his airway is clear and patent, > >His breathing is 18 breaths per min. normal pattern no difficulty, > >He has a good circulation capillary refill is <2 seconds with a palpable >radial pulse of 92 beats per min. It is regular and otherwise unremarkable. > >He is pyrexial with a temperature of 38.2'C. > >He complained of mild generalised abdominal pain with Diarrhea 3 times >today and moderate vomiting. > >The question is where do you go from here? > >Gareth > >_________________________________________________________________ Find a >cheaper internet access deal - choose one to suit you. >http://www.msn.co.uk/internetaccess > _________________________________________________________________ Chat via SMS. Simply send 'CHAT' to 1889918. More info at http://ninemsn.com.au/mobilemania/MoChat.asp?blipid=6800 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 Hi Gareth, Oral and IV rehydration would be good, as his symptoms and history indicate he has lost some fluid. High temperature, pale pallour, slight tachycardia, general acheing and GI upset may be the result of a few too many beers and/or food poisonning. He has not mentioned any headache, which is steering away from the alcohol option. Some questions that may be useful would be about where he lives, prior medical history, recent work history, quality of vomit and diarrhea (eg any blood, mucous etc), how rapid was the onset of symptoms. Nothing as yet, sounds alarming, but would ask him to come back later if he feels the same. There is very little to go on at present to suggest that he should be off work. If the pyrexia and pain increase, this may be something surgical. If blood appears in either vomit or diarrhea, possibly an ulcer. If blood is the main constituent, then something has gone pop and he needs to go ASAP. There is a suggestion of systemic infection and further localised pain already. Any thoughts folks? Cheers, Ross > > > OK guys this is my first attempt at > writing a scenario so be gentle with > me..... > > You are spending a constructive if > boring afternoon preparing the flight > lists in the installations clinic, > somewhere off the coast of west africa. > The drilling program keeps changing so > your lists are no sooner completed > than you have to start them all over > again! To top matters off it is again > raining heavily and you have to go > outside shortly to do the T cards and > lifeboat lists. > > You are interrupted by the appearance > of one of the ex pat new-starts on > board. He is looking rather pale and is > complaining of having " gastric Flu " > Which he blames on the barbeques that > he had whilst undergoing his induction > at the shore base. > > He complains of feeling " achy " like > when he had the flu last year. > > On examination you note that his airway > is clear and patent, > > His breathing is 18 breaths per min. > normal pattern no difficulty, > > He has a good circulation capillary > refill is <2 seconds with a palpable > radial pulse of 92 beats per min. It is > regular and otherwise unremarkable. > > He is pyrexial with a temperature of 38.2'C. > > He complained of mild generalised > abdominal pain with Diarrhea 3 times today > and moderate vomiting. > > The question is where do you go from here? > > Gareth > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 Take a full medical history (P.M.H,any current medications e.g malaria prohylaxis, known allergies) and document recent( last 24 hrs) fluid intake. Record full base-line observations: Pulse, B/P, Temperature, Resps,spo2. Test his urine. Are you aware of any other presentations from personnel having attended the same BBQ's etc? Consider contacting onshore clinics/facilities to make enquiries having excluded the issues below. Exclude the nasties first; 1. Malaria is a disease that may present in numerous forms and despite the generalised abdo pain he scores high on most of the other symptoms. Test for this if possible or certainly keep it in your mind as a possible cause. 2. Palpate his abdomen and exlude R.I.F pain (appendix). Otherwise treat symptomatically with I.M/I.V metoclopramide, copious oral fluids (if vomiting alleviated), oral rehydration solution/sachets, mild analgesic or anti-spasmodic. Restrict diet. Send a stool sample off asap. Keep him off work that day and review; administering antibiotics if the diarrhoea persists- as in my experience of West Africa, it always does!!( we are in the real world and everyone offshore is there to do a job; ours is to partly to get them back to being productive workers!) > >Oral rehydration of electrolytes (unless you need a bit of cannulation > >practice- 16 guage iv cannula and >Saline solution at .k.v.o. rate) over 4 > >four hour @ period 1.5 litres per hour > >A shot of maxillon i.m.-dose obviously dependant on body weight. > >Pulse oxometer in situ to view true oxygen stats for base line obs > >BP for base line obs.If all good... Send the little squeezer back to work.. > >youre caring Paramedic Mark. > > > > > > > >From: " GARETH THOMAS " Reply-To: To: > > Subject: Scenario > >Date: Mon, 22 Sep 2003 16:46:47 +0000 > > > >OK guys this is my first attempt at writing a scenario so be gentle with > >me..... > > > >You are spending a constructive if boring afternoon preparing the flight > >lists in the installations clinic, somewhere off the coast of west africa. > >The drilling program keeps changing so your lists are no sooner completed > >than you have to start them all over again! To top matters off it is again > >raining heavily and you have to go outside shortly to do the T cards and > >lifeboat lists. > > > >You are interrupted by the appearance of one of the ex pat new- starts on > >board. He is looking rather pale and is complaining of having " gastric Flu " > >Which he blames on the barbeques that he had whilst undergoing his > >induction at the shore base. > > > >He complains of feeling " achy " like when he had the flu last year. > > > >On examination you note that his airway is clear and patent, > > > >His breathing is 18 breaths per min. normal pattern no difficulty, > > > >He has a good circulation capillary refill is <2 seconds with a palpable > >radial pulse of 92 beats per min. It is regular and otherwise unremarkable. > > > >He is pyrexial with a temperature of 38.2'C. > > > >He complained of mild generalised abdominal pain with Diarrhea 3 times > >today and moderate vomiting. > > > >The question is where do you go from here? > > > >Gareth > > > >_________________________________________________________________ Find a > >cheaper internet access deal - choose one to suit you. > >http://www.msn.co.uk/internetaccess > > > > _________________________________________________________________ > Chat via SMS. Simply send 'CHAT' to 1889918. More info at > http://ninemsn.com.au/mobilemania/MoChat.asp?blipid=6800 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 Gareth, How are you doing. As Ross mentions Oral or IV Rehydration would be initial response until the picture becomes clearer. Obviously at this point, the guys have mentioned there isn't much to go on. It is basically a case of treating the S+S On initial exam of the patient. You mention he was pale, was the patient Myalgic or showing any evidence of jaundice in his eyes. The paleness may be indicative of sudden anaemia due to Malaria On examination of his throat, were there any other features such as dry coated tongue. Did the patient complain of thirst or discomfort in his mouth. As you mention, you are in West Africa, where a Pyrexia could be one of many things. In addition to the questions added by Ross. When did this gentleman arrive in country. If it was only a day or so ago for the 1st time, Hopefully that points to something less sinister such as Travel diarrhoea which one of the guys mentioned. You mention a key factor. He underwent induction on the shorebase, as a newstart. How long was he onshore How long has he now been offshore. Is he within the Parasites incubation period. Where was he prior to this, If he has been home from a previous assignment in a malarial region, did he continue to take his Anti-Malarial medication for the prescribed period at home. If this is his 1st ever trip to WA, has he continued his medication since he came offshore. This is often the most serious failing by personnel, who suddenly feel they are in no danger whilest home or when they come offshore, as such they discontinue prophylaxis. They forget that the Malaria Parasite is going through an incubation period and therefore they won't display symptoms during that time. Which type of Anti-Malarial is he on. Is he on an appropriate medication for WA. This may play an important part in any tx later should this prove to be the diagnosis. What is his vaccination history. Has he received immunisation for Typhoid Yellow Fever Hepatitis A etc Does he have any history of problems such as DU or other GI problems etc Did physical examination show any abdo signs, was he distended, where there any abnormalities on further exam, such as Enlarged Liver or Spleen. Does the patient display any rashes or spots on exam. You may want to check a Urinalysis and Blood sugar levels in addition to his vitals. These show several abnormalities in Malaria patients. As Ross states this guy has not mentioned Headaches. He could simply be a dehydration, food poisoning or a possible underlying surgical problem. Has anyone else reported similar symptoms We need to keep in mind that anyone on Anti-Malarials may well present with non specific problems such as a Low grade Pyrexia, generalised aches, myalgia or gastric symptoms. Nausea, and vomitting are common. Often the drug initially masks the severity of the condition and so classical signs such as Headache and high grade fever are not always as evident or as severe as would be expected. 38.2 may no be entirely demonstrative of this patients condition Do you have the ability to carry out ICT testing or other forms of rapid testing to check for Parasitaemia or takes slides to check under the microscope. Initial ICT tests might well not pick up Low levels of Parasite, especially if the symptoms have just begun after the incubation period and the Parasite is only starting to infiltrate the red blood cells. Be careful which anti-emetic you give, when treating the initial symptoms. Although at present, the S+S are not much to go on. If this is Malaria then Maxalon should not be given to patients on or who may receive Malarone as a treatment. Hopefully this patient will not turn out to be a Malarial patient. Especially in West Africa, we should never rule it out, even if the S+S do not appear to be truly indicative. Early diagnosis is extremely important as Fatalities can occur in a very short period of hours or days from the onset of symptoms with Falciparum cases. Cheers, Mark " Ross Boardman " <ross.boardman@ntl < > world.com> cc: Subject: RE: Scenario 09/22/03 09:49 PM Please respond to RemoteSupportMedic s Hi Gareth, Oral and IV rehydration would be good, as his symptoms and history indicate he has lost some fluid. High temperature, pale pallour, slight tachycardia, general acheing and GI upset may be the result of a few too many beers and/or food poisonning. He has not mentioned any headache, which is steering away from the alcohol option. Some questions that may be useful would be about where he lives, prior medical history, recent work history, quality of vomit and diarrhea (eg any blood, mucous etc), how rapid was the onset of symptoms. Nothing as yet, sounds alarming, but would ask him to come back later if he feels the same. There is very little to go on at present to suggest that he should be off work. If the pyrexia and pain increase, this may be something surgical. If blood appears in either vomit or diarrhea, possibly an ulcer. If blood is the main constituent, then something has gone pop and he needs to go ASAP. There is a suggestion of systemic infection and further localised pain already. Any thoughts folks? Cheers, Ross > > > OK guys this is my first attempt at > writing a scenario so be gentle with > me..... > > You are spending a constructive if > boring afternoon preparing the flight > lists in the installations clinic, > somewhere off the coast of west africa. > The drilling program keeps changing so > your lists are no sooner completed > than you have to start them all over > again! To top matters off it is again > raining heavily and you have to go > outside shortly to do the T cards and > lifeboat lists. > > You are interrupted by the appearance > of one of the ex pat new-starts on > board. He is looking rather pale and is > complaining of having " gastric Flu " > Which he blames on the barbeques that > he had whilst undergoing his induction > at the shore base. > > He complains of feeling " achy " like > when he had the flu last year. > > On examination you note that his airway > is clear and patent, > > His breathing is 18 breaths per min. > normal pattern no difficulty, > > He has a good circulation capillary > refill is <2 seconds with a palpable > radial pulse of 92 beats per min. It is > regular and otherwise unremarkable. > > He is pyrexial with a temperature of 38.2'C. > > He complained of mild generalised > abdominal pain with Diarrhea 3 times today > and moderate vomiting. > > The question is where do you go from here? > > Gareth > Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 22, 2003 Report Share Posted September 22, 2003 Hi could be simple diarrhoea or something more sinister, Check out the stools consistency is there blood ?? and lots of mucous .. Could possibbly be Amoebiaisis treat with Metronidazole . Could be typhoid fever or Salmonellosis both treated with Cipro, If he has been onshore and in country for more than 10 days you must rule out Malaria as this can present with diarrhoea and flu like symptoms.... Not always.. Use Optimal or Parasite F to confirm however even if negative be prepared to test again. If positive and as he is a non immune you would refer immediately for treatment, If not possible check blood sugar and start Quinine 20mg\kg IV over 4 hours and monitor ECG. Or Oral Quinine 600mg Q 8hrly for a week followed by 3 Fansidar ( If not allergic to Sulpher). Or Mefloquine, Malarone etc etc etc He could probably get away with oral rehydration if the vomiting subsides or following a dose of anti emetic otherwise IV fluid replacement. Generally West Coast of Africa.. If Infective diarrhoea then Usually Cipro or Metronidazole. If it was Cholera you would know about it as there would be an epidemic on the base and the typical apearence of the stools ( Rice water) Anyway there you go >From: " GARETH THOMAS " <gareththomas1@...> >Reply- > >Subject: Scenario >Date: Mon, 22 Sep 2003 16:46:47 +0000 > >OK guys this is my first attempt at writing a scenario so be gentle with >me..... > >You are spending a constructive if boring afternoon preparing the flight >lists in the installations clinic, somewhere off the coast of west africa. >The drilling program keeps changing so your lists are no sooner completed >than you have to start them all over again! To top matters off it is again >raining heavily and you have to go outside shortly to do the T cards and >lifeboat lists. > >You are interrupted by the appearance of one of the ex pat new-starts on >board. He is looking rather pale and is complaining of having " gastric Flu " >Which he blames on the barbeques that he had whilst undergoing his >induction >at the shore base. > >He complains of feeling " achy " like when he had the flu last year. > >On examination you note that his airway is clear and patent, > >His breathing is 18 breaths per min. normal pattern no difficulty, > >He has a good circulation capillary refill is <2 seconds with a palpable >radial pulse of 92 beats per min. It is regular and otherwise unremarkable. > >He is pyrexial with a temperature of 38.2'C. > >He complained of mild generalised abdominal pain with Diarrhea 3 times >today >and moderate vomiting. > >The question is where do you go from here? > >Gareth > >_________________________________________________________________ >Find a cheaper internet access deal - choose one to suit you. >http://www.msn.co.uk/internetaccess > _________________________________________________________________ Use MSN Messenger to send music and pics to your friends http://www.msn.co.uk/messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2003 Report Share Posted September 23, 2003 This sounds like food poisoning rehydrate with DI-oralight & lomitil for diarrhoea and keep on fluids for 24hrs, stool sample blood sample, bed down monitor for any change await results and treat accordingly. check to see if any one else has any symptoms,if patient can tolerate paracetamol 2 four hrly for temp --------------------------------- Want to chat instantly with your online friends? Get the FREE Messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2003 Report Share Posted September 23, 2003 Gareth Where are you based in EG. Are you in Bata or on Bioko " GARETH THOMAS " <gareththomas1@hot mail.com> cc: Subject: Re: Scenario 09/23/03 12:56 PM Please respond to RemoteSupportMedic s In answer to a few of the questions on initial presentation his BP was normotensive. The country that you are off the coast of is Equatorial Guinea. The patient has no past medical history and is not allergic to anything. You take him off duty and he is tolerating oral fluids although he is still vomiting from time to time and has diarrhea (no blood observed from either end). Something about his story does not ring true however and you check the personnel on board (POB) list. You find that although he is a new start in that this is his first trip he has already been on board for a week. Yet his symptoms are new. You go to check up on him and find that he has upper left quadrant abdominal pain and on examination there is a possible splenomegaly. His temperature is now 38.8'c and he has a headache. Gareth >From: " GARETH THOMAS " <gareththomas1@...> >Reply- > >Subject: Scenario >Date: Mon, 22 Sep 2003 16:46:47 +0000 > >OK guys this is my first attempt at writing a scenario so be gentle with >me..... > >You are spending a constructive if boring afternoon preparing the flight >lists in the installations clinic, somewhere off the coast of west africa. >The drilling program keeps changing so your lists are no sooner completed >than you have to start them all over again! To top matters off it is again >raining heavily and you have to go outside shortly to do the T cards and >lifeboat lists. > >You are interrupted by the appearance of one of the ex pat new-starts on >board. He is looking rather pale and is complaining of having " gastric Flu " >Which he blames on the barbeques that he had whilst undergoing his >induction >at the shore base. > >He complains of feeling " achy " like when he had the flu last year. > >On examination you note that his airway is clear and patent, > >His breathing is 18 breaths per min. normal pattern no difficulty, > >He has a good circulation capillary refill is <2 seconds with a palpable >radial pulse of 92 beats per min. It is regular and otherwise unremarkable. > >He is pyrexial with a temperature of 38.2'C. > >He complained of mild generalised abdominal pain with Diarrhea 3 times >today >and moderate vomiting. > >The question is where do you go from here? > >Gareth > >_________________________________________________________________ >Find a cheaper internet access deal - choose one to suit you. >http://www.msn.co.uk/internetaccess > _________________________________________________________________ Express yourself with cool emoticons - download MSN Messenger today! http://www.msn.co.uk/messenger Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 24, 2003 Report Share Posted September 24, 2003 OK Guys, A lot of you are on the correct track. Our casualty was on shore for 4 days prior to coming out to the rig. He is not on any antimalarial despite being advised what to take because a) they upset his stomach, he heard that they can send you nuts and c) it will never happen to him / if it happens it happens and that is what the medic is here for! The BBQs were in the evening and they stayed outside drinking until in to the night. He was wearing a short sleeved shirt ( " it was hot " ) and he didn't use an insectacide. His temp is now soaring to over 39'C and he is having occasional rigors. He is complaining of a more severe headache. He is getting drowsy and lethargic. A neuro exam reveals hyper reflexia. There is protein and blood in his urine. A BM stick of his blood sugar reveals him to be mildly hypoglycaemic You perform a rapid diagnostic malaria test (e.g. OptiMal) and it is positive for plasmodium falciparum. He is still vomiting. The question is what do we do now (apart from asking to change places with our back to backs). Gareth >From: " GARETH THOMAS " <gareththomas1@...> >Reply- > >Subject: Re: Scenario >Date: Tue, 23 Sep 2003 11:56:31 +0000 > >In answer to a few of the questions on initial presentation his BP was >normotensive. The country that you are off the coast of is Equatorial >Guinea. The patient has no past medical history and is not allergic to >anything. > >You take him off duty and he is tolerating oral fluids although he is still >vomiting from time to time and has diarrhea (no blood observed from either >end). > >Something about his story does not ring true however and you check the >personnel on board (POB) list. You find that although he is a new start in >that this is his first trip he has already been on board for a week. Yet >his >symptoms are new. > >You go to check up on him and find that he has upper left quadrant >abdominal >pain and on examination there is a possible splenomegaly. His temperature >is >now 38.8'c and he has a headache. > >Gareth > > > >From: " GARETH THOMAS " <gareththomas1@...> > >Reply- > > > >Subject: Scenario > >Date: Mon, 22 Sep 2003 16:46:47 +0000 > > > >OK guys this is my first attempt at writing a scenario so be gentle with > >me..... > > > >You are spending a constructive if boring afternoon preparing the flight > >lists in the installations clinic, somewhere off the coast of west >africa. > >The drilling program keeps changing so your lists are no sooner completed > >than you have to start them all over again! To top matters off it is >again > >raining heavily and you have to go outside shortly to do the T cards and > >lifeboat lists. > > > >You are interrupted by the appearance of one of the ex pat new-starts on > >board. He is looking rather pale and is complaining of having " gastric >Flu " > >Which he blames on the barbeques that he had whilst undergoing his > >induction > >at the shore base. > > > >He complains of feeling " achy " like when he had the flu last year. > > > >On examination you note that his airway is clear and patent, > > > >His breathing is 18 breaths per min. normal pattern no difficulty, > > > >He has a good circulation capillary refill is <2 seconds with a palpable > >radial pulse of 92 beats per min. It is regular and otherwise >unremarkable. > > > >He is pyrexial with a temperature of 38.2'C. > > > >He complained of mild generalised abdominal pain with Diarrhea 3 times > >today > >and moderate vomiting. > > > >The question is where do you go from here? > > > >Gareth > > > >_________________________________________________________________ > >Find a cheaper internet access deal - choose one to suit you. > >http://www.msn.co.uk/internetaccess > > > >_________________________________________________________________ >Express yourself with cool emoticons - download MSN Messenger today! >http://www.msn.co.uk/messenger > _________________________________________________________________ Stay in touch with absent friends - get MSN Messenger http://www.msn.co.uk/messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2003 Report Share Posted September 25, 2003 IV fluids. Antiemetic, IV Quinine infusion in 5% Dextrose 20mg\kg over 4 hours, Keep checking the Blood glucose, Arrange a Medevac to somewhere with greater expertise. Danger of Kidney failure, Massive haemolysis, Cerebral malaria and death, Get him to someone with better facilities. My humble opinion >From: " GARETH THOMAS " <gareththomas1@...> >Reply- > >Subject: Re: Scenario >Date: Wed, 24 Sep 2003 09:15:40 +0000 > >OK Guys, > >A lot of you are on the correct track. > >Our casualty was on shore for 4 days prior to coming out to the rig. > >He is not on any antimalarial despite being advised what to take because a) >they upset his stomach, he heard that they can send you nuts and c) it >will never happen to him / if it happens it happens and that is what the >medic is here for! > >The BBQs were in the evening and they stayed outside drinking until in to >the night. He was wearing a short sleeved shirt ( " it was hot " ) and he >didn't >use an insectacide. > >His temp is now soaring to over 39'C and he is having occasional rigors. He >is complaining of a more severe headache. He is getting drowsy and >lethargic. A neuro exam reveals hyper reflexia. There is protein and blood >in his urine. A BM stick of his blood sugar reveals him to be mildly >hypoglycaemic > >You perform a rapid diagnostic malaria test (e.g. OptiMal) and it is >positive for plasmodium falciparum. > >He is still vomiting. > >The question is what do we do now (apart from asking to change places with >our back to backs). > >Gareth > > > >From: " GARETH THOMAS " <gareththomas1@...> > >Reply- > > > >Subject: Re: Scenario > >Date: Tue, 23 Sep 2003 11:56:31 +0000 > > > >In answer to a few of the questions on initial presentation his BP was > >normotensive. The country that you are off the coast of is Equatorial > >Guinea. The patient has no past medical history and is not allergic to > >anything. > > > >You take him off duty and he is tolerating oral fluids although he is >still > >vomiting from time to time and has diarrhea (no blood observed from >either > >end). > > > >Something about his story does not ring true however and you check the > >personnel on board (POB) list. You find that although he is a new start >in > >that this is his first trip he has already been on board for a week. Yet > >his > >symptoms are new. > > > >You go to check up on him and find that he has upper left quadrant > >abdominal > >pain and on examination there is a possible splenomegaly. His temperature > >is > >now 38.8'c and he has a headache. > > > >Gareth > > > > > > >From: " GARETH THOMAS " <gareththomas1@...> > > >Reply- > > > > > >Subject: Scenario > > >Date: Mon, 22 Sep 2003 16:46:47 +0000 > > > > > >OK guys this is my first attempt at writing a scenario so be gentle >with > > >me..... > > > > > >You are spending a constructive if boring afternoon preparing the >flight > > >lists in the installations clinic, somewhere off the coast of west > >africa. > > >The drilling program keeps changing so your lists are no sooner >completed > > >than you have to start them all over again! To top matters off it is > >again > > >raining heavily and you have to go outside shortly to do the T cards >and > > >lifeboat lists. > > > > > >You are interrupted by the appearance of one of the ex pat new-starts >on > > >board. He is looking rather pale and is complaining of having " gastric > >Flu " > > >Which he blames on the barbeques that he had whilst undergoing his > > >induction > > >at the shore base. > > > > > >He complains of feeling " achy " like when he had the flu last year. > > > > > >On examination you note that his airway is clear and patent, > > > > > >His breathing is 18 breaths per min. normal pattern no difficulty, > > > > > >He has a good circulation capillary refill is <2 seconds with a >palpable > > >radial pulse of 92 beats per min. It is regular and otherwise > >unremarkable. > > > > > >He is pyrexial with a temperature of 38.2'C. > > > > > >He complained of mild generalised abdominal pain with Diarrhea 3 times > > >today > > >and moderate vomiting. > > > > > >The question is where do you go from here? > > > > > >Gareth > > > > > >_________________________________________________________________ > > >Find a cheaper internet access deal - choose one to suit you. > > >http://www.msn.co.uk/internetaccess > > > > > > >_________________________________________________________________ > >Express yourself with cool emoticons - download MSN Messenger today! > >http://www.msn.co.uk/messenger > > > >_________________________________________________________________ >Stay in touch with absent friends - get MSN Messenger >http://www.msn.co.uk/messenger > _________________________________________________________________ Hotmail messages direct to your mobile phone http://www.msn.co.uk/msnmobile Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 25, 2003 Report Share Posted September 25, 2003 Kristian, On board rig etc, Rapid malaria test ( I think) showed positive for Falciparum Malaria, In my experience Malaria can present with alsorts of symptoms including diffuse abdominal pain, Splenamegaly \ tender spleen could be du to the parasitaemia and haemolysis. This guy is in serious trouble unless treated with IV quinine as soon as possible and sent to an ICU if possible. Get ISOS to fly to South Africa. Brash ISOS Angola >From: KReninger@... >Reply- > >Subject: Re: Scenario >Date: Tue, 23 Sep 2003 19:35:32 EDT > >The plot thickens. I presume that the fever is constant and not cycling >in >the classical malaria sense. Any neck stiffness to go with the headache? >Any >S & S in other crewmembers? I would be tempted to ask about gal bladder >indications, but you note his pain to be in the upper left quadrant and the >continued diarrhea really doesn't go with that. What is your ability to >do >microscope or lab work via an I-stat on board? I would interested to see >if there >are any signs of parasites in his stool. The possible splenomegaly is of >concern. With the sustained fever and added physical findings, I would >think that >this patient may require a hospital/clinic work up beyond the means >available >to you. What's your threshold to evacuate him? > >I'm thinking from an emergency nurse's perspective, so I'm unsure of your >exact working environment and on board capabilities. > >Kristian Reninger >RN, BSN, CEN, NREMT-P > _________________________________________________________________ Use MSN Messenger to send music and pics to your friends http://www.msn.co.uk/messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 26, 2003 Report Share Posted September 26, 2003 Good scenario Gareth. Sorry, I didn't get to contribute further as I was on my way back to present work location. I have an article being published in the next issue of 'Emergency Nurse' in the U.K (?October) related to the increase in people returning to the U.K and then developing malaria symptoms/how to identify and manage it if they present to A & E. Beales > Thanks to everybody who has contributed to the malaria scenario. We will > wrap it up now as it has run its course. As I was saying it is the first > scenario that I have done. The reasons that i did it were many ranging from > the list being quiet, I wanted to learn by doing it (I have, thank you) and > I wanted to do one specifically on PF malaria. > > This is a subject that could touch anybody on the list. With the increase in > air travel more and more people are potentially getting exposed to this > parasite. Prior to my present job I had not come across it and it has ben a > steep learning curve. > > PF malaria is a horrendous disease. It is rapidly progressive and the > potential complications are absolutely horrible. they include: - > > Cerebral malaria - this can kill non immune people in less than 24 hours! > Acute renal failure - the old black water fever > Cardiac failure > Pulmonary oedema > Acute anemia and hypoxia to the extent that they can arrest and die. > DIC leading to gangrene and amputation > > If the malaria develops into a chronic condition late complications such as > tropical splenomegaly syndrome and nephrotic syndrome can result. > > Unfortunately every year we hear of expats dying from this disease. Many > times this is not in the countries where they work (as we are on the look > out for it), it is when they return home. They often see a family doctor who > may not even think about malaria and diagnoses a virus or " the flu " . By the > time the mis diagnosis is realised the situation is advanced and tragically > it is often too late. > > The biggest factor in surviving this disease is early diagnosis and correct > treatment. > > It is probably appropriate to suspect malaria in in anyone who returns from > a malarious area (even if the plane just stopped there and they did not get > off) if they develop a fever within three months of return (and possibly up > to 1 year after return). If in doubt treat for malaria. > > World wide it has been estimated that between 100 million and 150 million > people suffer from malaria and it kills an estimated 1 million people a > year. (puts SARS into perspective doesn't it!) > > Malaria is in many cases a preventable disease and a death from malaria is a > preventable death. > > Protect yourselves and if necessary seek early treatment. > > Keep safe, > > Gareth > > _________________________________________________________________ > Find a cheaper internet access deal - choose one to suit you. > http://www.msn.co.uk/internetaccess Quote Link to comment Share on other sites More sharing options...
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