Wednesday, June 30, 2010

what would you do? interesting case...

Had an interesting call this shift. Got dispatch Class 1 for an ill person (gotta love those!) Pt wife states pt was sitting in the recliner after dinner and was fine she went outside for a little bit and came back in and found him "sleeping" in the chair and then she tried to wake him and was unable to do so, so she called 911, stating he was unconscious for 5-10 min before we got there. Upon our arrival pt was awake and sitting in chair, pt appeared to be aware of what was going on but was unable to talk. Pt had a pituitary tumor 5 yrs ago and recently the doctors found another mass this time to his left frontal lobe, took a biopsy last week, pt still has sutures in from biopsy procedure, suture site looks healthy. Pt VS are all WNL and I worked out communications with pt by asking yes/no questions and having him squeeze my hand once for yes and twice for no and again he seemed like he was aware of what was going on but just couldnt talk! Blood sugar was 143, no facial droop or arm drift, pt could stand and pivot to stairchair and then again to stretcher with a steady gait. So I took the pt 50 miles (telling my driver I wanted an easy ride, but not to fiddle faddle around either, to use lights and sirens if needed) to the hospital where his biopsy was done instead of the local hospital.
I dont know if I didnt sound sure of myself or what but the triage nurse seemed to focus on the fact that he couldnt speak and the onset time of that and immediately jumped to stroke, and she completely ignored the fact that they had drilled into this mans brain a week she called a stroke team member in who performed the same tests I had done in the field (looking for facial droop, arm drift, or weakness in extremities and checked his pupils/gaze) and stated "this is not a brain attack". Seriously? If I had compelling evidence this was a CVA I would have flown him instead of taking him an hour by ground considering he was almost an hour and half into the episode. Maybe Im in the wrong here, maybe I was being egotistical, but I did comeplete my assessment, several times, in the field and assumed this was an issue with the mass/tumor they had found recently.  Upon arrival of the hospital the pt could answer "yeah" and "no" to questions but was still unable to even state his name.

What would you all have done? Taken him an hour by ground or flew him?

1 comment:

Ellie said...

That is interesting, if the bat team agreed that it wasn't a CVA then you probably did the right thing. Certainly sounds like the tumor (not) talking to me. Oh, bad joke.