Medical. : Medicine.

FM got it in one It's a PE at least thats what I was heading towards

Helo go read up on PE's. Remember an embolism is what killed that Today Show journalist in the early days of reporter being embedded with units.

ready for a new one??
 
Helo says I'm evil, so here goes:

You are walking down the "street" of your FOB, minding your own biz, when you hear "MEDIC!!!" coming from the nearby quarters. You just so happen to have your aid-bag slung on your shoulder as you are comming back from getting it resupplied. The FOB has a TMC on it.

When you arrive, you find a male soldier lying on his rack, completely dressed conscious but working really hard to breathe, face very flushed. His roomie tells you that your patient had just finished getting dressed for duty when he he began having speech problems and complaining of double vision. And then cried out in pain before falling back onto his rack.

next step in assessment?? anything you already suspect??
 
AB is done, check pulses and strip him. is he A&O? also, have roomie either get on my radio and get an ambulance over here, or get him to run to CQ or the TOC and get this guy a ride. I don't have 02.

without knowing where the pain is, I'm thinking DVT, or a stroke. anything abnormal with the head or chest? bilateral rise and fall? how's his pulse/motor/sensory? where's the pain? any radiculopathy? any signs of trauma? bleeding? deformities?
 
Roomie hustles off to find you some transpo.

While you are stripping off the guy, his consciousness begins slipping, his respers get even more labored and he begins to drool. At exam, body is essentially unremarkable but for the flushing and a small reddened area on one foot.

Eventually he begins jerking movements, (tetanic)
 
I need a bird ASAFP. Pt has been stung by a scorpion, and needs antivenom. also - ice him down with ice packs or frozen water bottles, and treat symptoms - secure airway (I should have done that sooner!!!) and prepare to breathe for him if necesary. also - treatment is similar to tetanus; prophylaxis with tetanus vaccine is called for if pt has not had one in past 5 years. Also - Pen V or Doxy, alternate is Metro.
 
KACHING He got it. This has personal significance for me. I was stung by one of those lil creamy white beasties while living in TX. He crawled into my bed and got me. Guess its only appro, since I AM a Scorpio.

I'll let the rest catch up before I post the next.
 
brain pickin' time - for Diarrhea lasting longer than, say 3-5 days.... when and why should I think about ABX vs loperamide.... or should I just try the loperamide and if it doesn't work, hit him with Levo or Metro, depending on whether it's suspected E. Coli or Giardia?

so far, I've been letting it run for 5-7 days, making the pt push fluids and seeing if it self-corrects, and if it doesn't, delve a little further. so far, no one's had the super-foul smelling stools that go with giardia, but it's mostly the 10-15 x's a day, i-gotta-run-right-now E. coli. 3 days of Levo, and they're all better. is there something else I could try, besides (essentially) shooting in the dark? labs, doctors, and microscopes are not available.
 
Here is a new one, right from the past USAR Medical course I took.

Highschool Pancake collpase, all haz-mats mitigated, multiple patients. Your pt. is pinned from waist below and lethargic. Thinking about crush/Rhabdo, what would you do assuming you are trained in USAR? OR civilian E.M.S. What are the considerations in regards to treatment?

F.M.
 
OK treatment at site Since you've said we already have a lethargic patient, I have to assume there's pretty significant blood loss issues. Get two big bore IV's going, one straight fluids say Ringers. The other a volume expander (like hespan) if you got it. O2/airway support. While extrication in process, make sure you dont have any closed head injuries, monitor VS, LOC, pupils. You have to assume some spine damage, so c-spine immobilization needs done, not to mention back board and such for post extrication.

Helo and I discussed the merits of do you or do you not have MAST ready? Unless your patient is the luckiest SOB alive, youre prob gonna have a para or worse post freeing him/her. MAST might also buy some blood loss time to preserve cerebral and core functions until you can transpo for surgcal intervention. In the most grim of situations, it may also buy family some precious last words time.
 
On it like flynn. Add treatment for crush/rhabdomyolisis. I.V. fluids, bicarb and calcium if needed for alkanization, membrane stabilzation, albuterol, d50 and insulin for potassium exchange to intracellular and possible hypoglycemia secondary to liver/kidney failure.

F.M.
 
OK Boyz n Girlz Ready for zee next scenario??

While riding in convoy on troop pullout, you hear an explosion several vehicles ahead of you. You of couse grab your bag and hump it forward.

One of the first few vehicles in convoy triggered an IED. Luckily, no one was killed, but the vehicle that triggered it was pitched forward into the rear of the preceeding vehicle from the explosion. Your patient is the driver of the pitched vehicle.

Initial head to toe after extrication: VS P-92 but regular, respers 16 w/ no audible wheezes or gurgles. PERRL. 3cm lac above right eye. Both hands abraded. Body armour intact. Obvious deformity of R tib/fib.

Initial actions after assessment??
 
(2): A.B.C.'s, typical P.H.T.L.S. primary / secondary survey, spinal prec, transport--> Civilian world: Level-2 trauma, Army world: Urgent status, Medevac, I.V.'s kvo, monitor and look for blast injuries especially hollow organ injuries (blast lung). Pain mangement as long as no head injury / splint if time permits. What is the G.C.S. / neuro. status. I am worried about internal / blast issues and the poss. of shock (even know the v/s. don't show it YET).

(1):Triage of course, # of patients, injuries, resources needed, scene secure / perimeter secure?

F.M.
 

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