# Crip's Monthly Question



## Polar Bear (Jan 18, 2007)

Need a weekly Question for young Crip


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## x SF med (Jan 18, 2007)

Polar Bear said:


> Need a weekly Question for young Crip



Young Crip will probably not be able to play - he's in shit deep training mode.

But, here we go anyway.....

Young Crip-hopper, riddle me this!

A young local NG soldier is found face down near the bottom of a steep incline after a training assault on a hill in the SW US.  GCS - 2, Resp shallow 20, unequal pupils - dilated fully, temp 103, skin hot, flushed, dry.   Other soldiers saw him "acting crazy".  His clothes are torn up and partially removed, he is twitching, pulse is racing (nearly uncountable).  What could have caused this?


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## gryfen (Jan 18, 2007)

peyote?


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## x SF med (Jan 18, 2007)

Survey says - wrong answer.


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## gryfen (Jan 18, 2007)

Okay, hummmnn.

Heat Stroke would be my other try, but there's got to be more to it than that.


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## Mav (Jan 18, 2007)

Define crazy... just unusual? Bizarre in an energetic fashion? What was the major mechanism of injury or is nothing readily apparent (ie falling off a cliff versus say a grand mal seizure)

Is his skin clammy or just dry?? Any apparent bodily injuries? Bleeding? Visible head trauma?? 

The loss of clothing is odd.. but a lot of the other symptoms can be attributed to heat stroke... seizures, high body temperature, fatigue, severe confusion, hot, dry skin that is flushed but not sweaty, rapid heart beat, hallucinations...

Are the clothes randomly torn up or is there a general area that seems to have been affected??


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## Mav (Jan 18, 2007)

Are we allowed to barge in on this, btw? :)


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## x SF med (Jan 18, 2007)

Pt is aphoretic.

looks as though the Pt was attempting to rip his own clothes off.

minor scrapes on exposed skin, no visible signs of major trauma

Crazy as in running and screaming, seemingly tearing at his clothes


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## Kiwi1988 (Jan 18, 2007)

x SF med said:


> Pt is aphoretic.
> 
> looks as though the Pt was attempting to rip his own clothes off.
> 
> ...



Does anyone know the last time this guy urinated? Pulse what its ? Is it fast slow irregular ? 

Any past history of substance abuse?

What is he saying? Even  crazed they will give you a clue of whats happening. 

Colour of the whites of his eyes are the yellowing? Blood shot?

What is his Blood Glucose Level?


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## 104TN (Jan 18, 2007)

Fire ants.


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## x SF med (Jan 18, 2007)

pulse is racing (nearly uncountable).  strong and irregular
Any past history of substance abuse?  Southwest American Indian - follows religion.
Sclera slightly off color, hazy
No glucodse testing available in the field


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## x SF med (Jan 18, 2007)

RLK said:


> Fire ants.



survey says - wrong answer.


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## Kiwi1988 (Jan 18, 2007)

x SF med said:


> Sclera slightly off color, hazy
> No glucodse testing available in the field



Is the eyes sucken?

Does his breath smell fruity?


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## x SF med (Jan 18, 2007)

Negative to both.


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## Kiwi1988 (Jan 18, 2007)

x SF med said:


> pulse is racing (nearly uncountable).  strong and irregular
> Any past history of substance abuse?  Southwest American Indian - follows religion.



He hasn't been smoking pot has he?


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## x SF med (Jan 18, 2007)

now that would be some really killer weed - 

survey says - wrong answer!

Please feel free to play again next week.


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## Mav (Jan 18, 2007)

But it's not a result of Mescaline use? 

MDMA, maybe? 

Sounds like a hallucinogen in his system or just cleared from his system... many cause severe rising in body temperatures... seizures.. obviously hallucinations... would be a cause of the cloudy sclera... 

Does he have any visible serious muscle cramping?


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## x SF med (Jan 18, 2007)

Ah, Ha - you are one smart Cookie there Miss Mav - on the right track - but...

Survey says - wrong answer  - not MDMA

Feel free to grab a parting gift on the way out, and play again next week.


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## Mav (Jan 18, 2007)

*blush* 

Now I'm waiting for the next one


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## Max Power (Jan 18, 2007)

Some type of snake bite?


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## x SF med (Jan 18, 2007)

Little quick on the draw there Max - bet your wife is really happy.

NOPE!  Now begone....  and don't forget to tune in for next week's episode.


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## Max Power (Jan 18, 2007)

x SF med said:


> Little quick on the draw there Max - bet your girlfriend is really happy.
> 
> NOPE!  Now begone....  and don't forget to tune in for next week's episode.



Wife ;)

And I came up with that all on my own, thank you!  Even though it was wrong


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## x SF med (Jan 18, 2007)

I am Dr. EEEEvil!  hehehehehehehehe


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## DoctorDoom (Jan 18, 2007)

How can his GCS be 2?


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## surgicalcric (Jan 18, 2007)

Scopolamine toxicity secondary to chewing on Jimsonweed...

Crip


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## x SF med (Jan 18, 2007)

Crip-
 You are my Hero!!!  on the first try too.
 Gotta come up with a hard one next time.


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## x SF med (Jan 18, 2007)

DoctorDoom said:


> How can his GCS be 2?



Scopalamine Toxicity is one of the few things that will leave you 'alive' at a GCS of 2 - you have no conciousness of the real world at all and can still be walking or talking without any coherrency of reality.


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## surgicalcric (Jan 18, 2007)

I'm no hero, just dedicated to being the best 18D I can be.  My future teammates deserve no less.  ;)

Crip


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## DoctorDoom (Jan 19, 2007)

x SF med said:


> Scopalamine Toxicity is one of the few things that will leave you 'alive' at a GCS of 2 - you have no conciousness of the real world at all and can still be walking or talking without any coherrency of reality.



You mean 3... the lowest possible score in the GCS scale is 3 for no ocular, verbal or motor response.


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## Mav (Jan 19, 2007)

Damn, Crip. You came, you saw, and damnit but you conquered, lol :)


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## Mav (Jan 19, 2007)

According to Cornell, symptoms for heavy poisoning but necessarily fatality are:

rapid pulse,         rapid breathing,        dilated pupils,
restlessness,       nervousness,            muscular twitching,
polydipsia,          frequent urination,     diarrhea,
depression,          anorexia,               weight loss

Argh! It seems so obvious, now, lol! ;)


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## Kiwi1988 (Jan 19, 2007)

Mav said:


> Argh! It seems so obvious, now, lol! ;)



LMAO!


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## Crusader74 (Jan 19, 2007)

Im just wondering Do you guys get a chance to work in an Hosp ER for training??


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## surgicalcric (Jan 19, 2007)

*The short answer to your question is yes.*

SOCM (Ranger, TF 160, SEAL, and MARSOC) guys have one field rotation where they rotate thru the ER at a Level 1 Trauma Center for 2 weeks and ride with EMS for the same.  SF Medics spent time, 24 days to be exact, in either a military hospital/TMC or one of 5 Indian Hospitals, this in addition to the SOCm rotation.  The SOC-T rotation focuses, or is meant to, on more clinical medicine as oposed to the trauma in the first rotation.  SFMS students rotate from the ER to orthopedics, to pediatrics, anesthesia, and the OR to name a few.   

Its a great opportunity to learn to say the least.

Have a very SF day.

Crip


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## DoctorDoom (Jan 19, 2007)

Damn Crip, nice call... I was like jimson what?

I had a few guys on my trauma team in NYC when they were going through SOCM and also at the ISR in the Burn Center.  It was funny how the guys all fit the mold for each service; :)  great guys, should ahve listened to that 18D hopeful named Brian who was trying to get me to join up then... 

Where ever you are Brian, stay safe.

Keep the knowledge coming Crip!


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## surgicalcric (Jan 19, 2007)

DoctorDoom said:


> ...It was funny how the guys all fit the mold for each service...



The young Rangers and the SARC guys were the ones who stood out the most in my SOCM class, as well as the ones with the worst grades.  They just never figured out why they had two eyes, two ears, yet only one mouth.

Crip


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## AF IDMT (Jan 21, 2007)

surgicalcric said:


> Scopolamine toxicity secondary to chewing on Jimsonweed...
> 
> Crip



Damn, that was impressive.  I was going down the snake bite road myself.  :doh: Good stuff, Crip.:)


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## rangerpsych (Jan 22, 2007)

Wish I had been able to go to SOCM... Would have been fun.


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## rangerpsych (Jan 22, 2007)

ok, so what's the plan, cric.


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## surgicalcric (Jan 22, 2007)

rangerpsych said:


> ok, so what's the plan, cric.



Secure Airway;
Initiate IV;
Ativan or Diazepam (premedication for treatment of fasciculations);
Physostigmine (treatment of acetylcholine toxicity);
NG tube with Activated Charcoal to absorb/lavage whatever is still in the stomach;
treat other injuries as identified; and
EVAC.

Crip


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## x SF med (Jan 22, 2007)

surgicalcric said:


> I'm no hero, just dedicated to being the best 18D I can be.  My future teammates deserve no less.  ;)
> 
> Crip



Most excellent answer young Crip-hopper!  Now teach Dougie that he should do the same.


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