- Joined
- Dec 28, 2006
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57 year old female is brought in by EMS. Last seen normal by the family last night. They recall her going to bed but this AM found her laying in the living room in a puddle of vomit. EMS brings her in c-collar/backboard. Medical history is significant for breast cancer in 1999. As far as the family knows, she is in remission.
She is poorly responsive and kind of nods when asked a question. She has foaming secretions at the mouth, is tachypnic at ~30 resp/min. She is intubated using RSI with etomidate and succinylcholine.
Post intubation VS: pulse 88, bp 106/72, temp 33C rectal, resp 29 (Succs has warn off and she needs minimal sedation. Sat is 95% on 50% and improves if she is suctioned every few minutes.
Pertinent PE findings:
No obvious head or other trauma. Pupils are 2 mm with intermittent upbeat nystagmus. She does not track with the eyes. Lung sounds have course rhonchi. Heart sounds are normal. Abdomen is soft with bowel sounds. She grimaces when the upper abdomen is palpated. She has bilateral tremors in the hands with occasional jerking movements of the arms and shoulders. Reflexes are brisk throughout with some weak but repetitive clonus. She seems to have decreased tone generally.
As you hold your nose from the diarrhea stench it is clear that she has been incontinent of stool and urine...likely more than once.
DDx and next steps?
She is poorly responsive and kind of nods when asked a question. She has foaming secretions at the mouth, is tachypnic at ~30 resp/min. She is intubated using RSI with etomidate and succinylcholine.
Post intubation VS: pulse 88, bp 106/72, temp 33C rectal, resp 29 (Succs has warn off and she needs minimal sedation. Sat is 95% on 50% and improves if she is suctioned every few minutes.
Pertinent PE findings:
No obvious head or other trauma. Pupils are 2 mm with intermittent upbeat nystagmus. She does not track with the eyes. Lung sounds have course rhonchi. Heart sounds are normal. Abdomen is soft with bowel sounds. She grimaces when the upper abdomen is palpated. She has bilateral tremors in the hands with occasional jerking movements of the arms and shoulders. Reflexes are brisk throughout with some weak but repetitive clonus. She seems to have decreased tone generally.
As you hold your nose from the diarrhea stench it is clear that she has been incontinent of stool and urine...likely more than once.
DDx and next steps?