Re: EMS Challenge

June 11, 2010

Two things immediately come to mind... CVA or substance abuse / drug

reaction...could be hypoglycemia, but need more information - I would

continue the assessment, need more information...

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator / Emergency Response Coordinator

Westlake Chemical

P.O. Box 228

36045 LA 30

Geismar, LA 70734-0228

e-Mail: lpowell@...

Telephone:

Fax:

Cell: 225.439-6552

Captain / Training Officer - 7th District Fire Department -

http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

%20FD707@...>

Captain / Training Officer - Geismar Fire Department -

http://www.apfire.us/ http://www.apfire.us/>

Industrial Fire World Advisory Board - Industrial Fire World

http://www.fireworld.com/>

Secretary - Geismar Area Mutual Aid Association (GAMA) -

http:www.gamaid.org

Affiliate Advisory Council - Texas: National Association of Emergency

Medical Technicians http://www.naemt.org/>

Board of Directors - Emergency Medical Services Association of Texas

(EMSAT) http://www.texasemsat.org/>

" Next to creating a life, the finest thing a man can do is save one. " -

Abraham Lincoln

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of ExLngHrn@...

Sent: Thursday, June 10, 2010 18:15

To: Paramedicine ; texasems-l

Subject: 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

June 11, 2010

Two things immediately come to mind... CVA or substance abuse / drug

reaction...could be hypoglycemia, but need more information - I would

continue the assessment, need more information...

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator / Emergency Response Coordinator

Westlake Chemical

P.O. Box 228

36045 LA 30

Geismar, LA 70734-0228

e-Mail: lpowell@...

Telephone:

Fax:

Cell: 225.439-6552

Captain / Training Officer - 7th District Fire Department -

http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

%20FD707@...>

Captain / Training Officer - Geismar Fire Department -

http://www.apfire.us/ http://www.apfire.us/>

Industrial Fire World Advisory Board - Industrial Fire World

http://www.fireworld.com/>

Secretary - Geismar Area Mutual Aid Association (GAMA) -

http:www.gamaid.org

Affiliate Advisory Council - Texas: National Association of Emergency

Medical Technicians http://www.naemt.org/>

Board of Directors - Emergency Medical Services Association of Texas

(EMSAT) http://www.texasemsat.org/>

" Next to creating a life, the finest thing a man can do is save one. " -

Abraham Lincoln

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of ExLngHrn@...

Sent: Thursday, June 10, 2010 18:15

To: Paramedicine ; texasems-l

Subject: 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

June 11, 2010

Two things immediately come to mind... CVA or substance abuse / drug

reaction...could be hypoglycemia, but need more information - I would

continue the assessment, need more information...

Les

NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

Senior Safety Coordinator / Emergency Response Coordinator

Westlake Chemical

P.O. Box 228

36045 LA 30

Geismar, LA 70734-0228

e-Mail: lpowell@...

Telephone:

Fax:

Cell: 225.439-6552

Captain / Training Officer - 7th District Fire Department -

http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

%20FD707@...>

Captain / Training Officer - Geismar Fire Department -

http://www.apfire.us/ http://www.apfire.us/>

Industrial Fire World Advisory Board - Industrial Fire World

http://www.fireworld.com/>

Secretary - Geismar Area Mutual Aid Association (GAMA) -

http:www.gamaid.org

Affiliate Advisory Council - Texas: National Association of Emergency

Medical Technicians http://www.naemt.org/>

Board of Directors - Emergency Medical Services Association of Texas

(EMSAT) http://www.texasemsat.org/>

" Next to creating a life, the finest thing a man can do is save one. " -

Abraham Lincoln

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of ExLngHrn@...

Sent: Thursday, June 10, 2010 18:15

To: Paramedicine ; texasems-l

Subject: 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

June 11, 2010

CVS is a very real possibility and is actually the current emergency.

What about her underlying condition is the reason for the CVA?

Wes Ogilvie

Sent from my iPhone

> Two things immediately come to mind... CVA or substance abuse / drug

> reaction...could be hypoglycemia, but need more information - I would

> continue the assessment, need more information...

>

> Les

>

> NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

>

> Senior Safety Coordinator / Emergency Response Coordinator

>

> Westlake Chemical

>

> P.O. Box 228

>

> 36045 LA 30

>

> Geismar, LA 70734-0228

>

> e-Mail: lpowell@...

>

> Telephone:

>

> Fax:

>

> Cell: 225.439-6552

>

> Captain / Training Officer - 7th District Fire Department -

> http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

> %20FD707@...>

>

> Captain / Training Officer - Geismar Fire Department -

> http://www.apfire.us/ http://www.apfire.us/>

>

> Industrial Fire World Advisory Board - Industrial Fire World

> http://www.fireworld.com/>

>

> Secretary - Geismar Area Mutual Aid Association (GAMA) -

> http:www.gamaid.org

>

> Affiliate Advisory Council - Texas: National Association of Emergency

> Medical Technicians http://www.naemt.org/>

>

> Board of Directors - Emergency Medical Services Association of Texas

> (EMSAT) http://www.texasemsat.org/>

>

> " Next to creating a life, the finest thing a man can do is save

> one. " -

> Abraham Lincoln

>

> ________________________________

>

> From: texasems-l [mailto:texasems-l ]

> On

> Behalf Of ExLngHrn@...

> Sent: Thursday, June 10, 2010 18:15

> To: Paramedicine ; texasems-l

> Subject: 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

>

June 11, 2010

CVS is a very real possibility and is actually the current emergency.

What about her underlying condition is the reason for the CVA?

Wes Ogilvie

Sent from my iPhone

> Two things immediately come to mind... CVA or substance abuse / drug

> reaction...could be hypoglycemia, but need more information - I would

> continue the assessment, need more information...

>

> Les

>

> NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

>

> Senior Safety Coordinator / Emergency Response Coordinator

>

> Westlake Chemical

>

> P.O. Box 228

>

> 36045 LA 30

>

> Geismar, LA 70734-0228

>

> e-Mail: lpowell@...

>

> Telephone:

>

> Fax:

>

> Cell: 225.439-6552

>

> Captain / Training Officer - 7th District Fire Department -

> http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

> %20FD707@...>

>

> Captain / Training Officer - Geismar Fire Department -

> http://www.apfire.us/ http://www.apfire.us/>

>

> Industrial Fire World Advisory Board - Industrial Fire World

> http://www.fireworld.com/>

>

> Secretary - Geismar Area Mutual Aid Association (GAMA) -

> http:www.gamaid.org

>

> Affiliate Advisory Council - Texas: National Association of Emergency

> Medical Technicians http://www.naemt.org/>

>

> Board of Directors - Emergency Medical Services Association of Texas

> (EMSAT) http://www.texasemsat.org/>

>

> " Next to creating a life, the finest thing a man can do is save

> one. " -

> Abraham Lincoln

>

> ________________________________

>

> From: texasems-l [mailto:texasems-l ]

> On

> Behalf Of ExLngHrn@...

> Sent: Thursday, June 10, 2010 18:15

> To: Paramedicine ; texasems-l

> Subject: 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

>

June 11, 2010

CVS is a very real possibility and is actually the current emergency.

What about her underlying condition is the reason for the CVA?

Wes Ogilvie

Sent from my iPhone

> Two things immediately come to mind... CVA or substance abuse / drug

> reaction...could be hypoglycemia, but need more information - I would

> continue the assessment, need more information...

>

> Les

>

> NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF

>

> Senior Safety Coordinator / Emergency Response Coordinator

>

> Westlake Chemical

>

> P.O. Box 228

>

> 36045 LA 30

>

> Geismar, LA 70734-0228

>

> e-Mail: lpowell@...

>

> Telephone:

>

> Fax:

>

> Cell: 225.439-6552

>

> Captain / Training Officer - 7th District Fire Department -

> http://www.apfire.us/ http://www.apfire.us/> e-Mail: FD707@...

> %20FD707@...>

>

> Captain / Training Officer - Geismar Fire Department -

> http://www.apfire.us/ http://www.apfire.us/>

>

> Industrial Fire World Advisory Board - Industrial Fire World

> http://www.fireworld.com/>

>

> Secretary - Geismar Area Mutual Aid Association (GAMA) -

> http:www.gamaid.org

>

> Affiliate Advisory Council - Texas: National Association of Emergency

> Medical Technicians http://www.naemt.org/>

>

> Board of Directors - Emergency Medical Services Association of Texas

> (EMSAT) http://www.texasemsat.org/>

>

> " Next to creating a life, the finest thing a man can do is save

> one. " -

> Abraham Lincoln

>

> ________________________________

>

> From: texasems-l [mailto:texasems-l ]

> On

> Behalf Of ExLngHrn@...

> Sent: Thursday, June 10, 2010 18:15

> To: Paramedicine ; texasems-l

> Subject: 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

>

June 11, 2010

How are the eyes? And evidence of jaundice? Skin color?

How about the abdomen? Distension or swollen organs?

Granberry

> >

> > > Since Enbrel can cause demyelinating cns disorders I am going to

> > > guess neuro issues from the Enbrel

> > > Rick

> > > Sent via Blackberry

> > >

> > > ________________________________

> > > From: texasems-l texasems-l >

> > > To: texasems-l texasems-l >

> > > Sent: Thu Jun 10 18:35:40 2010

> > > Subject: 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> 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> [texasems-l

> > %40yahoogroups.com>] On Behalf Of

> > > ExLngHrn@...

> > > [ExLngHrn@... ]

> > > Sent: Thursday, June 10, 2010 6:14 PM

> > > To: Paramedicine

> > %40yahoogroups.com>; texasems-l

> > %40yahoogroups.com>

> > > Subject: 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

> > >

June 11, 2010

No jaundice. Pupils unequal. Skin is pink, warm, dry.

Abdomen is not abnormal.

-Wes

In a message dated 6/11/2010 4:27:19 P.M. Central Daylight Time,

holcaul@... writes:

How are the eyes? And evidence of jaundice? Skin color?

How about the abdomen? Distension or swollen organs?

Granberry

> >

> > > Since Enbrel can cause demyelinating cns disorders I am going to

> > > guess neuro issues from the Enbrel

> > > Rick

> > > Sent via Blackberry

> > >

> > > ________________________________

> > > From: _texasems-l _

(mailto:texasems-l ) _texasems-l _

(mailto:texasems-l ) >

> > > To: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto:texasems-l ) >

> > > Sent: Thu Jun 10 18:35:40 2010

> > > Subject: 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> 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 _

(mailto:texasems-l )

> > %40yahoogroups.com> [_texasems-l _

(mailto:texasems-l )

> > %40yahoogroups.com>] On Behalf Of

> > > ExLngHrn@...

> > > [ExLngHrn@... ]

> > > Sent: Thursday, June 10, 2010 6:14 PM

> > > To: _Paramedicine _

(mailto:Paramedicine )

> > %40yahoogroups.com>; _texasems-l _

(mailto:texasems-l )

> > %40yahoogroups.com>

> > > Subject: 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

> > >

June 11, 2010

Brachial is not palpable. Carotid and femoral are both strong and regular.

-Wes

In a message dated 6/11/2010 4:28:24 P.M. Central Daylight Time,

bradsattler@... writes:

Wes,

Is there a weakly palpable bracheal and a more pronounced femoral pulse?

Also, would you describe the carotid as a bounding pulse?

-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

>

> [Non-text portions of this message have been removed]

>

> ***** Named to Fortune's 1000 list for 2009****

>

> ***** Ranked in Industry Week's " 1000 Largest Manufacturing

> Companies in the World " 2009 list. *****

>

> *

June 11, 2010

Wes,

Is there a weakly palpable bracheal and a more pronounced femoral pulse?

Also, would you describe the carotid as a bounding pulse?

-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

>

June 11, 2010

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

drdugud@... writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

bradsattler@...>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

Close.... but no cigar.

-Wes

In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time,

rick.moore@... writes:

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto:texasems-l ) >

To: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto:texasems-l ) >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

_drdugud@..._ (mailto:drdugud@...)

writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known

to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

_bradsattler@..._ (mailto:bradsattler@...)

>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

does she have tender temples?

ck

In a message dated 6/11/2010 20:55:02 Central Daylight Time,

ExLngHrn@... writes:

Close.... but no cigar.

-Wes

In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time,

_rick.moore@..._ (mailto:rick.moore@...) writes:

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: __texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) )

__texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) ) >

To: __texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) )

__texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) ) >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

__drdugud@..._ (mailto:_drdugud@...) _

(mailto:_drdugud@..._ (mailto:drdugud@...) )

writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known

to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

__bradsattler@..._ (mailto:_bradsattler@...) _

(mailto:_bradsattler@..._ (mailto:bradsattler@...) )

>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

no.

-Wes

In a message dated 6/11/2010 8:57:07 P.M. Central Daylight Time,

krin135@... writes:

does she have tender temples?

ck

In a message dated 6/11/2010 20:55:02 Central Daylight Time,

_ExLngHrn@..._ (mailto:ExLngHrn@...) writes:

Close.... but no cigar.

-Wes

In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time,

__rick.moore@..._ (mailto:_rick.moore@...) _

(mailto:_rick.moore@..._ (mailto:rick.moore@...) ) writes:

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: ___texasems-l _ (mailto:__texasems-l )

_ (mailto:__texasems-l _

(mailto:_texasems-l ) ) _

(mailto:__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _ (mailto:texasems-l )

) )

___texasems-l _ (mailto:__texasems-l ) _

(mailto:__texasems-l _ (mailto:_texasems-l ) ) _

(mailto:__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _ (mailto:texasems-l )

) ) >

To: ___texasems-l _ (mailto:__texasems-l ) _

(mailto:__texasems-l _ (mailto:_texasems-l )

) _

(mailto:__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _ (mailto:texasems-l )

) )

___texasems-l _ (mailto:__texasems-l ) _

(mailto:__texasems-l _ (mailto:_texasems-l ) ) _

(mailto:__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _ (mailto:texasems-l )

) ) >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

___drdugud@..._ (mailto:__drdugud@...) _

(mailto:__drdugud@..._ (mailto:_drdugud@...) ) _

(mailto:__drdugud@..._ (mailto:_drdugud@...) _

(mailto:_drdugud@..._ (mailto:drdugud@...) ) )

writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known

to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

___bradsattler@..._ (mailto:__bradsattler@...) _

(mailto:__bradsattler@..._ (mailto:_bradsattler@...) ) _

(mailto:__bradsattler@..._ (mailto:_bradsattler@...) _

(mailto:_bradsattler@..._ (mailto:bradsattler@...) ) )

>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

how are her pupillary responses?

ck

In a message dated 6/11/2010 20:55:02 Central Daylight Time,

ExLngHrn@... writes:

Close.... but no cigar.

-Wes

In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time,

_rick.moore@..._ (mailto:rick.moore@...) writes:

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: __texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) )

__texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) ) >

To: __texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) )

__texasems-l _ (mailto:_texasems-l ) _

(mailto:_texasems-l _ (mailto:texasems-l ) ) >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

__drdugud@..._ (mailto:_drdugud@...) _

(mailto:_drdugud@..._ (mailto:drdugud@...) )

writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known

to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

__bradsattler@..._ (mailto:_bradsattler@...) _

(mailto:_bradsattler@..._ (mailto:bradsattler@...) )

>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

Ascites? Fistula? Dialysis patient?

Kelley

Sent on the SprintÂ® Now Network from my BlackBerryÂ®

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

> > >

June 11, 2010

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@... writes:

Can you play this game somewhere else.

________________________________

From: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto:texasems-l ) >

To: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto: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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

As a BASIC I learn a fair amount from these types of discussions and when I

am lost I use DELETE.

Seems to work well.

Once again EMS eats their young while bitching out of the other side of the

mouth about how we get no respect.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 6/11/2010 10:26:25 P.M. Central Daylight Time,

staffdoc9109@... writes:

Mr Cardenas,

You must be kidding. As one of the moderators of this list I commend Wes

for starting such a productive discussion. I think Dr Krin said it best that

this is a teaching discussion. If you don't like the thread then hit

delete.

Bernie Stafford EMTP

-----Original Message-----

From: _texasems-l _ (mailto:texasems-l )

[mailto:_texasems-l _ (mailto:texasems-l ) ] On

Behalf Of Cardenas,

Sent: Friday, June 11, 2010 10:17 PM

To: _texasems-l _ (mailto:texasems-l )

Subject: Re: EMS challenge

Then answer the ? And stop clogging up the site.

________________________________

From: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto:texasems-l ) >

To: _texasems-l _ (mailto:texasems-l )

_texasems-l _ (mailto: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@..._

(mailto:luis.cardenas@...)

writes:

Can you play this game somewhere else.

________________________________

From: __texasems-l _ (mailto:_texasems-l )

_

(mailto:_texasems-l _ (mailto:texasems-l )

)

__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _

(mailto:texasems-l ) ) >

To: __texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _

(mailto:texasems-l )

)

__texasems-l _ (mailto:_texasems-l )

_ (mailto:_texasems-l _

(mailto: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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler bradsattler@...>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

June 11, 2010

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: texasems-l texasems-l >

To: texasems-l texasems-l >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

drdugud@... writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

bradsattler@...>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

June 11, 2010

DVT that breaks off and travels to the brain?

From: texasems-l [mailto:texasems-l ] On Behalf

Of ExLngHrn@...

Sent: Friday, June 11, 2010 8:55 PM

To: texasems-l

Subject: Re: EMS challenge

Close.... but no cigar.

-Wes

In a message dated 6/11/2010 8:54:06 P.M. Central Daylight Time,

rick.moore@... writes:

Cva due to atherosclerosis secondary to rheumotoid arthritis

Rick

Sent via Blackberry

________________________________

From: _texasems-l _

(mailto:texasems-l )

_texasems-l _

(mailto:texasems-l ) >

To: _texasems-l _

(mailto:texasems-l )

_texasems-l _

(mailto:texasems-l ) >

Sent: Fri Jun 11 20:34:11 2010

Subject: Re: EMS challenge

Very close. It's a CVA. But is the CVA caused by the Enbrel? Or is it

more likely that the CVA is caused by a condition she's taking Enbrel for?

(BIG HINT THERE)

-Wes

In a message dated 6/11/2010 7:22:55 P.M. Central Daylight Time,

_drdugud@... _ (mailto:drdugud@...

)

writes:

CVA from Enbrel use. Enbrel is a TNF inhibitor. This drug class is known

to

cause demyelinating CNS disorders.

Close?

Neil

On Thu, Jun 10, 2010 at 10:54 PM, Brad Sattler

_bradsattler@... _

(mailto:bradsattler@... )

>wrote:

>

> Wes,

>

> Would you describe this patient as " thin " by any chance?

>

> -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

> >

June 11, 2010

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

> > >

> > > [Non-text portions of this message have been removed]

> > >

> > > ------------------------------------

> > >

June 11, 2010

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

> >

June 11, 2010

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

> >

> > [Non-text portions of this message have been removed]

> >

> > ------------------------------------

> >

> > Yahoo! Groups Links

> >

> > [Non-text portions of this message have been removed]

> >

June 11, 2010

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

> > > >

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