Announcement

Collapse
No announcement yet.

Robodoc's Trauma Puzzle # 1

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Robodoc's Trauma Puzzle # 1

    22 year old man brought to ED by ambulance as level I trauma in full spinal precautions. Patient is comatose and seizing. No history is available from patient. Girlfriend is on her way in by POV. Per paramedic run sheet, patient was sitting on the balcony of his second story apartment when his girlfriend left to go shopping. When she returned, she found patient on sidewalk below their apartment balcony bleeding from scalp and seizing. She called 911. Paramedics report PMH/FH negative. No meds. No allergies.

    On exam: Vitals: BP=176/110, P=120, R=32, SaO2 = 97% room air
    Primary trauma survey: airway, breathing and circulation are intact
    Secondary trauma survey: 5 cm left frontal scalp laceration near hairline
    Ears normal - no hemotympanum, pupils 3 mm reactive, gaze conjugate, no APD and no EPD. Mouth & tongue with blood and laceration from biting to left lateral tongue. Neck supple without visible or palpable trauma. Lungs clear
    Heart tachycardia without murmur. Abd scaphoid and soft, bowel tones quiet. Extremities: tonic-clonic posturing Neuro: seizing, no focal findings, GCS = 5 (E1, V1, M3)

  • #2
    1. Ruptured cerebral aneurysm
    2. Generalized seizure
    3. Drugs

    Comment


    • #3
      Securing venous access, and giving benzodiazepine for seizure. Accucheck for glucose level? Foley and urine drug screen? History of alcohol or drug use?

      Comment


      • #4
        IV access secured, patient intubated, IV lorazepam and IV load of Cerebyx given (1.5 grams over 40 minutes). Seizing resolves. Initial labs: WBC=18K with 85 Segs & 11 Bands; Platelets 235K, lytes normal, renal function normal, glucose = 95 mgm%, PT/INR normal; UA normal; ECG NSR with prolonged QT.
        Urine drug screen positive for cocaine, THC, PCP, opioids and benzos. CT Brain negative.

        What information is missing that you would like to know?
        Ragster

        Comment


        • #5
          temp?
          Are ALL these guys septic?

          Comment


          • #6
            Yes Anon, does sound septic
            Bigdoc

            Comment


            • #7
              Long QT syndrome with VT induced by cocaine use leading to LOC and fall.

              Comment


              • #8
                Rectal temp = 103.5 degrees F
                Ragster

                Comment


                • #9
                  Lumbar puncture?
                  HIV test?

                  Comment


                  • #10
                    Malignant hyperthermia? CPK needed (although fall and muscle trauma may affect it)

                    Comment


                    • #11
                      Originally posted by hirschr
                      Malignant hyperthermia? CPK needed (although fall and muscle trauma may affect it)
                      I agree with H
                      Mel
                      There is no place like 127.0.0.1

                      Comment

                      Working...
                      X