Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Well, no matter what one's certification level is, there is something to be learned from scenarios. For example, if one is a Basic EMT, it would seem to be of great interest that a patient had no obtainable blood pressures in either arm but a heart rate of only 72. If I were an EMT-B, I would be asking, WHY and trying to learn something. As a paramedic I'm reviewing all the causes I can think of right now and attempting to eliminate all except the right one. A low or unobtainable BP " should " trigger an increase in heart rate through catecholamine release (WHAT? Basics don't know that? They should). So why is that not happening here? Also, a Basic EMT ought to be able to spot signs of a CVA or TIA when they're as plain as in the scenario. There's a great deal for Basic EMTs to learn from this scenario. If you can't get a BP in either arm, then where else can you try? What conditions can lead to absent palpable blood pressures or different BPs in the arms? This scenario happens to be a real puzzler, which should at least tempt one to do some Googling, unless one is perfectly satisfied with one's current level of knowledge. If the Doc doesn't have it yet, it's probably a pretty good learning scenario. Just sayin. With malice to none. Gene G. EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but > they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do > find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying > etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Well, no matter what one's certification level is, there is something to be learned from scenarios. For example, if one is a Basic EMT, it would seem to be of great interest that a patient had no obtainable blood pressures in either arm but a heart rate of only 72. If I were an EMT-B, I would be asking, WHY and trying to learn something. As a paramedic I'm reviewing all the causes I can think of right now and attempting to eliminate all except the right one. A low or unobtainable BP " should " trigger an increase in heart rate through catecholamine release (WHAT? Basics don't know that? They should). So why is that not happening here? Also, a Basic EMT ought to be able to spot signs of a CVA or TIA when they're as plain as in the scenario. There's a great deal for Basic EMTs to learn from this scenario. If you can't get a BP in either arm, then where else can you try? What conditions can lead to absent palpable blood pressures or different BPs in the arms? This scenario happens to be a real puzzler, which should at least tempt one to do some Googling, unless one is perfectly satisfied with one's current level of knowledge. If the Doc doesn't have it yet, it's probably a pretty good learning scenario. Just sayin. With malice to none. Gene G. EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but > they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do > find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying > etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 Just pray it's not where you or yours live and play. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > Makes me wonder where this person is a medic and what their > certification level is. > > Further affiant sayeth not. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 22:17, " Cardenas, " luis.cardenas@... > > wrote: > > > Then answer the ? And stop clogging up the site. > > > > ________________________________ > > > > From: texasems-l texasems-l > > > To: texasems-l texasems-l > > > Sent: Fri Jun 11 21:59:05 2010 > > Subject: Re: EMS challenge > > > > > > > > > > Senor Cardenas: > > > > What game? > > > > a good paramedic is offering a case scenario (and doing a decent job > > of > > it), practicing his teaching skills while trying to get other folks > > to think > > outside the paramedic cook book. This is the sort of thing that we > > need more > > of on the various paramedic groups. I can assure you that there are > > similar cases being presented on the 'real' medical groups all the > > time, albeit > > frequently being posed in search of other treatment options for > really > > screwy (read zebra or even unicorn) cases. > > > > ck > > > > > > In a message dated 6/11/2010 21:55:09 Central Daylight Time, > > luis.cardenas@... > %40dallascityhall.com> writes: > > > > Can you play this game somewhere else. > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > To: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > Sent: Fri Jun 11 21:41:09 2010 > > Subject: Re: EMS challenge > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential > > diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but > > it's also possible that engorged lymph nodes are blocking peripheral > > circulation and causing increased vascular pressure system-wide, > > leading to a > > brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 I could be so lucky ________________________________ From: texasems-l texasems-l > To: texasems-l texasems-l > Sent: Fri Jun 11 23:05:21 2010 Subject: Re: EMS challenge Just pray it's not where you or yours live and play. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... On Jun 11, 2010, at 22:44, Wes Ogilvie ExLngHrn@... > wrote: > Makes me wonder where this person is a medic and what their > certification level is. > > Further affiant sayeth not. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 22:17, " Cardenas, " luis.cardenas@... > > wrote: > > > Then answer the ? And stop clogging up the site. > > > > ________________________________ > > > > From: texasems-l texasems-l > > > To: texasems-l texasems-l > > > Sent: Fri Jun 11 21:59:05 2010 > > Subject: Re: EMS challenge > > > > > > > > > > Senor Cardenas: > > > > What game? > > > > a good paramedic is offering a case scenario (and doing a decent job > > of > > it), practicing his teaching skills while trying to get other folks > > to think > > outside the paramedic cook book. This is the sort of thing that we > > need more > > of on the various paramedic groups. I can assure you that there are > > similar cases being presented on the 'real' medical groups all the > > time, albeit > > frequently being posed in search of other treatment options for > really > > screwy (read zebra or even unicorn) cases. > > > > ck > > > > > > In a message dated 6/11/2010 21:55:09 Central Daylight Time, > > luis.cardenas@... > %40dallascityhall.com> writes: > > > > Can you play this game somewhere else. > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > To: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > Sent: Fri Jun 11 21:41:09 2010 > > Subject: Re: EMS challenge > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential > > diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but > > it's also possible that engorged lymph nodes are blocking peripheral > > circulation and causing increased vascular pressure system-wide, > > leading to a > > brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 I could be so lucky ________________________________ From: texasems-l texasems-l > To: texasems-l texasems-l > Sent: Fri Jun 11 23:05:21 2010 Subject: Re: EMS challenge Just pray it's not where you or yours live and play. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... On Jun 11, 2010, at 22:44, Wes Ogilvie ExLngHrn@... > wrote: > Makes me wonder where this person is a medic and what their > certification level is. > > Further affiant sayeth not. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 22:17, " Cardenas, " luis.cardenas@... > > wrote: > > > Then answer the ? And stop clogging up the site. > > > > ________________________________ > > > > From: texasems-l texasems-l > > > To: texasems-l texasems-l > > > Sent: Fri Jun 11 21:59:05 2010 > > Subject: Re: EMS challenge > > > > > > > > > > Senor Cardenas: > > > > What game? > > > > a good paramedic is offering a case scenario (and doing a decent job > > of > > it), practicing his teaching skills while trying to get other folks > > to think > > outside the paramedic cook book. This is the sort of thing that we > > need more > > of on the various paramedic groups. I can assure you that there are > > similar cases being presented on the 'real' medical groups all the > > time, albeit > > frequently being posed in search of other treatment options for > really > > screwy (read zebra or even unicorn) cases. > > > > ck > > > > > > In a message dated 6/11/2010 21:55:09 Central Daylight Time, > > luis.cardenas@... > %40dallascityhall.com> writes: > > > > Can you play this game somewhere else. > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > To: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > Sent: Fri Jun 11 21:41:09 2010 > > Subject: Re: EMS challenge > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential > > diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but > > it's also possible that engorged lymph nodes are blocking peripheral > > circulation and causing increased vascular pressure system-wide, > > leading to a > > brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2010 Report Share Posted June 11, 2010 I could be so lucky ________________________________ From: texasems-l texasems-l > To: texasems-l texasems-l > Sent: Fri Jun 11 23:05:21 2010 Subject: Re: EMS challenge Just pray it's not where you or yours live and play. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... On Jun 11, 2010, at 22:44, Wes Ogilvie ExLngHrn@... > wrote: > Makes me wonder where this person is a medic and what their > certification level is. > > Further affiant sayeth not. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 22:17, " Cardenas, " luis.cardenas@... > > wrote: > > > Then answer the ? And stop clogging up the site. > > > > ________________________________ > > > > From: texasems-l texasems-l > > > To: texasems-l texasems-l > > > Sent: Fri Jun 11 21:59:05 2010 > > Subject: Re: EMS challenge > > > > > > > > > > Senor Cardenas: > > > > What game? > > > > a good paramedic is offering a case scenario (and doing a decent job > > of > > it), practicing his teaching skills while trying to get other folks > > to think > > outside the paramedic cook book. This is the sort of thing that we > > need more > > of on the various paramedic groups. I can assure you that there are > > similar cases being presented on the 'real' medical groups all the > > time, albeit > > frequently being posed in search of other treatment options for > really > > screwy (read zebra or even unicorn) cases. > > > > ck > > > > > > In a message dated 6/11/2010 21:55:09 Central Daylight Time, > > luis.cardenas@... > %40dallascityhall.com> writes: > > > > Can you play this game somewhere else. > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > To: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ) > > _texasems-l > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > > Sent: Fri Jun 11 21:41:09 2010 > > Subject: Re: EMS challenge > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential > > diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but > > it's also possible that engorged lymph nodes are blocking peripheral > > circulation and causing increased vascular pressure system-wide, > > leading to a > > brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Caucasian. However her underlying medical history is more common in Asian females. Wes Sent from my iPhone > what is the ethnic background of the patient? > > ck > > > In a message dated 6/11/2010 22:42:45 Central Daylight Time, > ExLngHrn@... writes: > > Alas, no. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 21:41, " Brad Sattler " _bradsattler@..._ > (mailto:bradsattler@...) > wrote: > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but it's also possible that engorged lymph nodes are > > blocking peripheral circulation and causing increased vascular > > pressure system-wide, leading to a brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Moya moya syndrome > make that *much* more common in relatively young Asian females. > > this is a real zebra, almost a unicorn. > > I recall seeing *one* patient with this disease in 35 years of > practice. > > ck > > > In a message dated 6/12/2010 01:43:07 Central Daylight Time, > ExLngHrn@... writes: > > > > > Caucasian. However her underlying medical history is more common in > Asian females. > > Wes > > Sent from my iPhone > > On Jun 12, 2010, at 1:33, _krin135@..._ (mailto:krin135@...) > wrote: > >> what is the ethnic background of the patient? >> >> ck >> >> >> In a message dated 6/11/2010 22:42:45 Central Daylight Time, >> _ExLngHrn@..._ (mailto:ExLngHrn@...) writes: >> >> Alas, no. >> >> Wes >> >> Sent from my iPhone >> >> On Jun 11, 2010, at 21:41, " Brad Sattler " __bradsattler@..._ > (mailto:_bradsattler@...) _ >> (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) > > wrote: >> >>> Yeah, I was working toward lymphoma Wes, but we're trying to >>> differential diagnose here. >>> >>> Her possible demyialation (sp?) might be causing stroke-like >>> symptoms, but it's also possible that engorged lymph nodes are >>> blocking peripheral circulation and causing increased vascular >>> pressure system-wide, leading to a brain bleed. >>> . >>> Is that getting close? >>> >>> -Brad >>> >>> Sent via BlackBerry, the office that follows you. >>> >>> EMS challenge >>>>> >>>>> Since it's been a while since Professor Gandy offered a >> challenge >>>>> (and the >>>>> prize-winner's trip to Ladonia), I present the following brain- >>>>> teaser for >>>>> all of y'all. Alas, there are no prizes since the half-star >> hotel >>>>> resort >>>>> in Ladonia is closed for fumigation. >>>>> >>>>> On to the challenge...... you are dispatched to an altered >> mental >>>>> status >>>>> call. Upon arrival, you find a middle-aged female laying on the >>>>> floor of an >>>>> office. She is semi-coherent and semi-combative, with slurred >>>>> speech. Her >>>>> co-workers know that she has an extensive medical history, but >>> they >>>>> can't >>>>> remember what it is. >>>>> >>>>> Oddly, while the patient is breathing and speaking (although >>>>> abnormally), >>>>> you cannot obtain a radial pulse or a blood pressure. You do >>> find a >>>>> palpable carotid pulse at 72 bpm. >>>>> >>>>> What is happening to the patient and what is the underlying >>> etiology? >>>>> >>>>> -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. >>>>> -Attorney at Law/Licensed Paramedic >>>>> -Austin, Texas >>>>> >>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Moya moya syndrome > make that *much* more common in relatively young Asian females. > > this is a real zebra, almost a unicorn. > > I recall seeing *one* patient with this disease in 35 years of > practice. > > ck > > > In a message dated 6/12/2010 01:43:07 Central Daylight Time, > ExLngHrn@... writes: > > > > > Caucasian. However her underlying medical history is more common in > Asian females. > > Wes > > Sent from my iPhone > > On Jun 12, 2010, at 1:33, _krin135@..._ (mailto:krin135@...) > wrote: > >> what is the ethnic background of the patient? >> >> ck >> >> >> In a message dated 6/11/2010 22:42:45 Central Daylight Time, >> _ExLngHrn@..._ (mailto:ExLngHrn@...) writes: >> >> Alas, no. >> >> Wes >> >> Sent from my iPhone >> >> On Jun 11, 2010, at 21:41, " Brad Sattler " __bradsattler@..._ > (mailto:_bradsattler@...) _ >> (mailto:_bradsattler@..._ (mailto:bradsattler@...) ) > > wrote: >> >>> Yeah, I was working toward lymphoma Wes, but we're trying to >>> differential diagnose here. >>> >>> Her possible demyialation (sp?) might be causing stroke-like >>> symptoms, but it's also possible that engorged lymph nodes are >>> blocking peripheral circulation and causing increased vascular >>> pressure system-wide, leading to a brain bleed. >>> . >>> Is that getting close? >>> >>> -Brad >>> >>> Sent via BlackBerry, the office that follows you. >>> >>> EMS challenge >>>>> >>>>> Since it's been a while since Professor Gandy offered a >> challenge >>>>> (and the >>>>> prize-winner's trip to Ladonia), I present the following brain- >>>>> teaser for >>>>> all of y'all. Alas, there are no prizes since the half-star >> hotel >>>>> resort >>>>> in Ladonia is closed for fumigation. >>>>> >>>>> On to the challenge...... you are dispatched to an altered >> mental >>>>> status >>>>> call. Upon arrival, you find a middle-aged female laying on the >>>>> floor of an >>>>> office. She is semi-coherent and semi-combative, with slurred >>>>> speech. Her >>>>> co-workers know that she has an extensive medical history, but >>> they >>>>> can't >>>>> remember what it is. >>>>> >>>>> Oddly, while the patient is breathing and speaking (although >>>>> abnormally), >>>>> you cannot obtain a radial pulse or a blood pressure. You do >>> find a >>>>> palpable carotid pulse at 72 bpm. >>>>> >>>>> What is happening to the patient and what is the underlying >>> etiology? >>>>> >>>>> -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. >>>>> -Attorney at Law/Licensed Paramedic >>>>> -Austin, Texas >>>>> >>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 How do her nails look? Sent from the itty bitty keyboard on my iPhone > Caucasian. However her underlying medical history is more common in > Asian females. > > Wes > > Sent from my iPhone > > > > > what is the ethnic background of the patient? > > > > ck > > > > > > In a message dated 6/11/2010 22:42:45 Central Daylight Time, > > ExLngHrn@... writes: > > > > Alas, no. > > > > Wes > > > > Sent from my iPhone > > > > On Jun 11, 2010, at 21:41, " Brad Sattler " _bradsattler@..._ > > (mailto:bradsattler@...) > wrote: > > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > > differential diagnose here. > > > > > > Her possible demyialation (sp?) might be causing stroke-like > > > symptoms, but it's also possible that engorged lymph nodes are > > > blocking peripheral circulation and causing increased vascular > > > pressure system-wide, leading to a brain bleed. > > > . > > > Is that getting close? > > > > > > -Brad > > > > > > Sent via BlackBerry, the office that follows you. > > > > > > EMS challenge > > > > > > > > > > Since it's been a while since Professor Gandy offered a > > challenge > > > > > (and the > > > > > prize-winner's trip to Ladonia), I present the following > brain- > > > > > teaser for > > > > > all of y'all. Alas, there are no prizes since the half-star > > hotel > > > > > resort > > > > > in Ladonia is closed for fumigation. > > > > > > > > > > On to the challenge...... you are dispatched to an altered > > mental > > > > > status > > > > > call. Upon arrival, you find a middle-aged female laying on > the > > > > > floor of an > > > > > office. She is semi-coherent and semi-combative, with slurred > > > > > speech. Her > > > > > co-workers know that she has an extensive medical history, but > > > they > > > > > can't > > > > > remember what it is. > > > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > > abnormally), > > > > > you cannot obtain a radial pulse or a blood pressure. You do > > > find a > > > > > palpable carotid pulse at 72 bpm. > > > > > > > > > > What is happening to the patient and what is the underlying > > > etiology? > > > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > > -Attorney at Law/Licensed Paramedic > > > > > -Austin, Texas > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 How do her nails look? Sent from the itty bitty keyboard on my iPhone > Caucasian. However her underlying medical history is more common in > Asian females. > > Wes > > Sent from my iPhone > > > > > what is the ethnic background of the patient? > > > > ck > > > > > > In a message dated 6/11/2010 22:42:45 Central Daylight Time, > > ExLngHrn@... writes: > > > > Alas, no. > > > > Wes > > > > Sent from my iPhone > > > > On Jun 11, 2010, at 21:41, " Brad Sattler " _bradsattler@..._ > > (mailto:bradsattler@...) > wrote: > > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > > differential diagnose here. > > > > > > Her possible demyialation (sp?) might be causing stroke-like > > > symptoms, but it's also possible that engorged lymph nodes are > > > blocking peripheral circulation and causing increased vascular > > > pressure system-wide, leading to a brain bleed. > > > . > > > Is that getting close? > > > > > > -Brad > > > > > > Sent via BlackBerry, the office that follows you. > > > > > > EMS challenge > > > > > > > > > > Since it's been a while since Professor Gandy offered a > > challenge > > > > > (and the > > > > > prize-winner's trip to Ladonia), I present the following > brain- > > > > > teaser for > > > > > all of y'all. Alas, there are no prizes since the half-star > > hotel > > > > > resort > > > > > in Ladonia is closed for fumigation. > > > > > > > > > > On to the challenge...... you are dispatched to an altered > > mental > > > > > status > > > > > call. Upon arrival, you find a middle-aged female laying on > the > > > > > floor of an > > > > > office. She is semi-coherent and semi-combative, with slurred > > > > > speech. Her > > > > > co-workers know that she has an extensive medical history, but > > > they > > > > > can't > > > > > remember what it is. > > > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > > abnormally), > > > > > you cannot obtain a radial pulse or a blood pressure. You do > > > find a > > > > > palpable carotid pulse at 72 bpm. > > > > > > > > > > What is happening to the patient and what is the underlying > > > etiology? > > > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > > -Attorney at Law/Licensed Paramedic > > > > > -Austin, Texas > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Let's concentrate: patient has NO OBTAINABLE BLOOD PRESSURES in either arm. Patient has signs of TIA/CVA So far, we've not investigated much more. We're guessing. Wes said the key was unobtainable BPs in either upper extremity. Why would that happen? Why would heart rate be at 72 with a BP of NOTHING when taken in the upper extremities and the patient's LOC is still intact? What would a careful inspection of the patient (physical exam) show that might make a difference. GG EMS challenge >>>>> >>>>> Since it's been a while since Professor Gandy offered a >> challenge >>>>> (and the >>>>> prize-winner's trip to Ladonia), I present the following brain- >>>>> teaser for >>>>> all of y'all. Alas, there are no prizes since the half-star >> hotel >>>>> resort >>>>> in Ladonia is closed for fumigation. >>>>> >>>>> On to the challenge...... you are dispatched to an altered >> mental >>>>> status >>>>> call. Upon arrival, you find a middle-aged female laying on the >>>>> floor of an >>>>> office. She is semi-coherent and semi-combative, with slurred >>>>> speech. Her >>>>> co-workers know that she has an extensive medical history, but >>> they >>>>> can't >>>>> remember what it is. >>>>> >>>>> Oddly, while the patient is breathing and speaking (although >>>>> abnormally), >>>>> you cannot obtain a radial pulse or a blood pressure. You do >>> find a >>>>> palpable carotid pulse at 72 bpm. >>>>> >>>>> What is happening to the patient and what is the underlying >>> etiology? >>>>> >>>>> -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. >>>>> -Attorney at Law/Licensed Paramedic >>>>> -Austin, Texas >>>>> >>>>> [Non-text portions of this message have been removed] >>>>> >>>>> ------------------------------------ >>>>> >>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Let's concentrate: patient has NO OBTAINABLE BLOOD PRESSURES in either arm. Patient has signs of TIA/CVA So far, we've not investigated much more. We're guessing. Wes said the key was unobtainable BPs in either upper extremity. Why would that happen? Why would heart rate be at 72 with a BP of NOTHING when taken in the upper extremities and the patient's LOC is still intact? What would a careful inspection of the patient (physical exam) show that might make a difference. GG EMS challenge >>>>> >>>>> Since it's been a while since Professor Gandy offered a >> challenge >>>>> (and the >>>>> prize-winner's trip to Ladonia), I present the following brain- >>>>> teaser for >>>>> all of y'all. Alas, there are no prizes since the half-star >> hotel >>>>> resort >>>>> in Ladonia is closed for fumigation. >>>>> >>>>> On to the challenge...... you are dispatched to an altered >> mental >>>>> status >>>>> call. Upon arrival, you find a middle-aged female laying on the >>>>> floor of an >>>>> office. She is semi-coherent and semi-combative, with slurred >>>>> speech. Her >>>>> co-workers know that she has an extensive medical history, but >>> they >>>>> can't >>>>> remember what it is. >>>>> >>>>> Oddly, while the patient is breathing and speaking (although >>>>> abnormally), >>>>> you cannot obtain a radial pulse or a blood pressure. You do >>> find a >>>>> palpable carotid pulse at 72 bpm. >>>>> >>>>> What is happening to the patient and what is the underlying >>> etiology? >>>>> >>>>> -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. >>>>> -Attorney at Law/Licensed Paramedic >>>>> -Austin, Texas >>>>> >>>>> [Non-text portions of this message have been removed] >>>>> >>>>> ------------------------------------ >>>>> >>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Wes, I did the research and found the zebra. It was not kuru, sadly. Methylprednisolone via med control permission would be my treatment (another clue). I can't find the tie-in to stroke, is there a corroboration I'm missing? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Wes, I did the research and found the zebra. It was not kuru, sadly. Methylprednisolone via med control permission would be my treatment (another clue). I can't find the tie-in to stroke, is there a corroboration I'm missing? -Brad Sent via BlackBerry, the office that follows you. EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a > challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star > hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered > mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 You're a " fire captain? " How the hell did you get to be a fire captain? Only because of a system that rewards incompetence. GG EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but > they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do > find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying > etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 So, Mr. Cardenas, what do you want and expect from this forum? I have not seen you contribute to it up to now, when you have expressed your objections to a scenario discussion that's going on. What have you contributed to this forum? Nothing that I can see. I understand that you're a Captain in Dallas Fire Rescue. Does your attitude represent that of DFR? Or are you simply posting as an individual? Please clarify. You say, " hitting delete too muCh too often. " What does that mean? What would you like to see this list be? You're a member. Tell us what you want to see here. And post something positive. We would all be glad to see some positive input from the Dallas Fire EMS people, but sadly, we seldom get anything that makes sense. In fact, we don't see ANYTHING from Dallas FR. Gene Gandy, JD, LP, NREMT-P EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 So, Mr. Cardenas, what do you want and expect from this forum? I have not seen you contribute to it up to now, when you have expressed your objections to a scenario discussion that's going on. What have you contributed to this forum? Nothing that I can see. I understand that you're a Captain in Dallas Fire Rescue. Does your attitude represent that of DFR? Or are you simply posting as an individual? Please clarify. You say, " hitting delete too muCh too often. " What does that mean? What would you like to see this list be? You're a member. Tell us what you want to see here. And post something positive. We would all be glad to see some positive input from the Dallas Fire EMS people, but sadly, we seldom get anything that makes sense. In fact, we don't see ANYTHING from Dallas FR. Gene Gandy, JD, LP, NREMT-P EMS challenge > > > > Since it's been a while since Professor Gandy offered a challenge > > (and the > > prize-winner's trip to Ladonia), I present the following brain- > > teaser for > > all of y'all. Alas, there are no prizes since the half-star hotel > > resort > > in Ladonia is closed for fumigation. > > > > On to the challenge...... you are dispatched to an altered mental > > status > > call. Upon arrival, you find a middle-aged female laying on the > > floor of an > > office. She is semi-coherent and semi-combative, with slurred > > speech. Her > > co-workers know that she has an extensive medical history, but they > > can't > > remember what it is. > > > > Oddly, while the patient is breathing and speaking (although > > abnormally), > > you cannot obtain a radial pulse or a blood pressure. You do find a > > palpable carotid pulse at 72 bpm. > > > > What is happening to the patient and what is the underlying etiology? > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > -Attorney at Law/Licensed Paramedic > > -Austin, Texas > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Gosh, some people get all pissy when they're stumped for an answer. > > Can you play this game somewhere else. > > ________________________________ > > From: texasems-l > texasems-l > > To: texasems-l > texasems-l > > Sent: Fri Jun 11 21:41:09 2010 > Subject: Re: EMS challenge > > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > differential diagnose here. > > Her possible demyialation (sp?) might be causing stroke-like symptoms, > but it's also possible that engorged lymph nodes are blocking > peripheral circulation and causing increased vascular pressure > system-wide, leading to a brain bleed. > . > Is that getting close? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Gosh, some people get all pissy when they're stumped for an answer. > > Can you play this game somewhere else. > > ________________________________ > > From: texasems-l > texasems-l > > To: texasems-l > texasems-l > > Sent: Fri Jun 11 21:41:09 2010 > Subject: Re: EMS challenge > > > > > Yeah, I was working toward lymphoma Wes, but we're trying to > differential diagnose here. > > Her possible demyialation (sp?) might be causing stroke-like symptoms, > but it's also possible that engorged lymph nodes are blocking > peripheral circulation and causing increased vascular pressure > system-wide, leading to a brain bleed. > . > Is that getting close? > > -Brad > > Sent via BlackBerry, the office that follows you. > > EMS challenge > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > (and the > > > prize-winner's trip to Ladonia), I present the following brain- > > > teaser for > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > resort > > > in Ladonia is closed for fumigation. > > > > > > On to the challenge...... you are dispatched to an altered mental > > > status > > > call. Upon arrival, you find a middle-aged female laying on the > > > floor of an > > > office. She is semi-coherent and semi-combative, with slurred > > > speech. Her > > > co-workers know that she has an extensive medical history, but they > > > can't > > > remember what it is. > > > > > > Oddly, while the patient is breathing and speaking (although > > > abnormally), > > > you cannot obtain a radial pulse or a blood pressure. You do find a > > > palpable carotid pulse at 72 bpm. > > > > > > What is happening to the patient and what is the underlying etiology? > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > -Attorney at Law/Licensed Paramedic > > > -Austin, Texas > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Oooh, he's a witty little fire captain, ain't he? Must have taken him, like... *forever* to come up with that one, since I don't recall ever seeing him posting here before today. > > AlASS. I think so. > > ________________________________ > > From: texasems-l > texasems-l > > To: texasems-l > texasems-l > > Sent: Fri Jun 11 22:42:08 2010 > Subject: Re: EMS challenge > > > > > Alas, no. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 21:41, " Brad Sattler " bradsattler@... > > > wrote: > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but it's also possible that engorged lymph nodes are > > blocking peripheral circulation and causing increased vascular > > pressure system-wide, leading to a brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Oooh, he's a witty little fire captain, ain't he? Must have taken him, like... *forever* to come up with that one, since I don't recall ever seeing him posting here before today. > > AlASS. I think so. > > ________________________________ > > From: texasems-l > texasems-l > > To: texasems-l > texasems-l > > Sent: Fri Jun 11 22:42:08 2010 > Subject: Re: EMS challenge > > > > > Alas, no. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 21:41, " Brad Sattler " bradsattler@... > > > wrote: > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but it's also possible that engorged lymph nodes are > > blocking peripheral circulation and causing increased vascular > > pressure system-wide, leading to a brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Oooh, he's a witty little fire captain, ain't he? Must have taken him, like... *forever* to come up with that one, since I don't recall ever seeing him posting here before today. > > AlASS. I think so. > > ________________________________ > > From: texasems-l > texasems-l > > To: texasems-l > texasems-l > > Sent: Fri Jun 11 22:42:08 2010 > Subject: Re: EMS challenge > > > > > Alas, no. > > Wes > > Sent from my iPhone > > On Jun 11, 2010, at 21:41, " Brad Sattler " bradsattler@... > > > wrote: > > > Yeah, I was working toward lymphoma Wes, but we're trying to > > differential diagnose here. > > > > Her possible demyialation (sp?) might be causing stroke-like > > symptoms, but it's also possible that engorged lymph nodes are > > blocking peripheral circulation and causing increased vascular > > pressure system-wide, leading to a brain bleed. > > . > > Is that getting close? > > > > -Brad > > > > Sent via BlackBerry, the office that follows you. > > > > EMS challenge > > > > > > > > Since it's been a while since Professor Gandy offered a challenge > > > > (and the > > > > prize-winner's trip to Ladonia), I present the following brain- > > > > teaser for > > > > all of y'all. Alas, there are no prizes since the half-star hotel > > > > resort > > > > in Ladonia is closed for fumigation. > > > > > > > > On to the challenge...... you are dispatched to an altered mental > > > > status > > > > call. Upon arrival, you find a middle-aged female laying on the > > > > floor of an > > > > office. She is semi-coherent and semi-combative, with slurred > > > > speech. Her > > > > co-workers know that she has an extensive medical history, but > > they > > > > can't > > > > remember what it is. > > > > > > > > Oddly, while the patient is breathing and speaking (although > > > > abnormally), > > > > you cannot obtain a radial pulse or a blood pressure. You do > > find a > > > > palpable carotid pulse at 72 bpm. > > > > > > > > What is happening to the patient and what is the underlying > > etiology? > > > > > > > > -Wes Ogilvie, MPA, JD, NREMT-P/Lic.P. > > > > -Attorney at Law/Licensed Paramedic > > > > -Austin, Texas > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Gene you forget even smart people can't be educated if the close thier mind. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > Well, no matter what one's certification level is, there is > something to be learned from scenarios. For example, if one is a > Basic EMT, it would seem to be of great interest that a patient had > no obtainable blood pressures in either arm but a heart rate of only > 72. If I were an EMT-B, I would be asking, WHY and trying to learn > something. As a paramedic I'm reviewing all the causes I can think > of right now and attempting to eliminate all except the right one. > > A low or unobtainable BP " should " trigger an increase in heart rate > through catecholamine release (WHAT? Basics don't know that? They > should). So why is that not happening here? > > Also, a Basic EMT ought to be able to spot signs of a CVA or TIA > when they're as plain as in the scenario. > > There's a great deal for Basic EMTs to learn from this scenario. If > you can't get a BP in either arm, then where else can you try? What > conditions can lead to absent palpable blood pressures or different > BPs in the arms? > > This scenario happens to be a real puzzler, which should at least > tempt one to do some Googling, unless one is perfectly satisfied > with one's current level of knowledge. > > If the Doc doesn't have it yet, it's probably a pretty good learning > scenario. > > Just sayin. > > With malice to none. > > Gene G. > > Re: EMS challenge > > > > > > > > > > > > > > > > Your scene is a fairly normal office building. Blood sugar is > > 128 mg/ > > > > dL. > > > > Pupils unequal. Obvious weakness left side when you check a > stroke > > > > scale. > > > > No medical alert tag. No obvious signs of trauma. The only > > medicine > > > > you find on scene is a box containing a drug called Enbrel. > > > > > > > > -Wes > > > > > > > > > > > > In a message dated 6/10/2010 6:29:32 P.M. Central Daylight Time, > > > > _lrichardson@... > %40ci.duncanville.tx.us> _ > > (mailto:lrichardson@... > %40ci.duncanville.tx.us> ) %40ci.duncanville.tx.us>; > > > > > > > > %40ci.duncanville.tx.us> writes: > > > > > > > > Ok Professor Wes! > > > > > > > > Some clues please! scene findings? other VS's? Blood Sugar? > Stroke > > > > Scale? Pupils? Obvious trauma? medical alert tags? meds on > scene? > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ; ) > > ; > > > > texasems-l > > > > %40yahoogroups.com> > > [_texasems-l ; > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > ; %40yahoogroups.com> > > > > > > %40yahoogroups.com>] On Behalf Of > > > > _ExLngHrn@... ; _ (mailto:ExLngHrn@... > > ; ) > > ; > > %2540aol.com>>; > > > > > > > [_ExLngHrn@... ; _ (mailto:ExLngHrn@... > > ; ) > > ; > > %2540aol.com>>;] > > > > > > > Sent: Thursday, June 10, 2010 6:14 PM > > > > To: _Paramedicine > %40yahoogroups.com> _ > > (mailto:Paramedicine > %40yahoogroups.com> ) ; > > > > > > > > %40yahoogroups.com>; > > _texasems-l %40yahoogroups.com>; _ > > (mailto:texasems-l > %40yahoogroups.com> ) > > ; Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2010 Report Share Posted June 12, 2010 Gene you forget even smart people can't be educated if the close thier mind. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos. (Cell) LNMolino@... > Well, no matter what one's certification level is, there is > something to be learned from scenarios. For example, if one is a > Basic EMT, it would seem to be of great interest that a patient had > no obtainable blood pressures in either arm but a heart rate of only > 72. If I were an EMT-B, I would be asking, WHY and trying to learn > something. As a paramedic I'm reviewing all the causes I can think > of right now and attempting to eliminate all except the right one. > > A low or unobtainable BP " should " trigger an increase in heart rate > through catecholamine release (WHAT? Basics don't know that? They > should). So why is that not happening here? > > Also, a Basic EMT ought to be able to spot signs of a CVA or TIA > when they're as plain as in the scenario. > > There's a great deal for Basic EMTs to learn from this scenario. If > you can't get a BP in either arm, then where else can you try? What > conditions can lead to absent palpable blood pressures or different > BPs in the arms? > > This scenario happens to be a real puzzler, which should at least > tempt one to do some Googling, unless one is perfectly satisfied > with one's current level of knowledge. > > If the Doc doesn't have it yet, it's probably a pretty good learning > scenario. > > Just sayin. > > With malice to none. > > Gene G. > > Re: EMS challenge > > > > > > > > > > > > > > > > Your scene is a fairly normal office building. Blood sugar is > > 128 mg/ > > > > dL. > > > > Pupils unequal. Obvious weakness left side when you check a > stroke > > > > scale. > > > > No medical alert tag. No obvious signs of trauma. The only > > medicine > > > > you find on scene is a box containing a drug called Enbrel. > > > > > > > > -Wes > > > > > > > > > > > > In a message dated 6/10/2010 6:29:32 P.M. Central Daylight Time, > > > > _lrichardson@... > %40ci.duncanville.tx.us> _ > > (mailto:lrichardson@... > %40ci.duncanville.tx.us> ) %40ci.duncanville.tx.us>; > > > > > > > > %40ci.duncanville.tx.us> writes: > > > > > > > > Ok Professor Wes! > > > > > > > > Some clues please! scene findings? other VS's? Blood Sugar? > Stroke > > > > Scale? Pupils? Obvious trauma? medical alert tags? meds on > scene? > > > > ________________________________ > > > > From: _texasems-l > %40yahoogroups.com> _ (mailto:texasems-l > > ; ) > > ; > > > > texasems-l > > > > %40yahoogroups.com> > > [_texasems-l ; > > _ (mailto:texasems-l > %40yahoogroups.com> ) > > ; %40yahoogroups.com> > > > > > > %40yahoogroups.com>] On Behalf Of > > > > _ExLngHrn@... ; _ (mailto:ExLngHrn@... > > ; ) > > ; > > %2540aol.com>>; > > > > > > > [_ExLngHrn@... ; _ (mailto:ExLngHrn@... > > ; ) > > ; > > %2540aol.com>>;] > > > > > > > Sent: Thursday, June 10, 2010 6:14 PM > > > > To: _Paramedicine > %40yahoogroups.com> _ > > (mailto:Paramedicine > %40yahoogroups.com> ) ; > > > > > > > > %40yahoogroups.com>; > > _texasems-l %40yahoogroups.com>; _ > > (mailto:texasems-l > %40yahoogroups.com> ) > > ; Quote Link to comment Share on other sites More sharing options...
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