Just looking for a round-table type discussion on this hypothetical scenario.
35 year old male, calls 911 after he been vomiting "nonstop" for the past "three or four hours." Complains of abdominal pain 10/10, has sharp grimace on his face, appears lethargic but restless. Eyes appear heavy but he paces from the bed to the room. Your gut instinct is that he is in significant pain, has been vomiting a lot, and can't find a comfortable position. Toilet has a small amount of bile in it, but he's only dry-heaving now.
History- TBI, hypothyroidism, denies any other.
States he has had these episodes on and off over the past year and a half, has lost a significant amount of weight (100lbs), and has been seen a few times and the hospital "doesn't do anything to fix it."
Meds- Trazodone, Gabapentin, Bupropion, Disulfiram, Levothyroxine. Pill counts are estimated but appear correct for prescription dates.
Vitals on scene
BP 160/100
HR 50
98% room air
RR 16
Lungs clear all fields
Pupils =/R
In the truck you notice the heart rate is 48-50. PT is lethargic but answers all questions appropriately. States his eyes are closed because he is "tired." 12 lead unremarkable - sinus brady.
IV is started, your partner gives 4mg zofran, 100mcg fentanyl, and hangs NS wide open. Normal traffic transport.
Enroute heart rate noted to be as low as 36, BP remains hypertensive, PT states pain is unchanged post Fentanyl. PT still alert and oriented.
What else do you want to know? What else do you want to do? What is included in your field impression/differential diagnoses?
35 year old male, calls 911 after he been vomiting "nonstop" for the past "three or four hours." Complains of abdominal pain 10/10, has sharp grimace on his face, appears lethargic but restless. Eyes appear heavy but he paces from the bed to the room. Your gut instinct is that he is in significant pain, has been vomiting a lot, and can't find a comfortable position. Toilet has a small amount of bile in it, but he's only dry-heaving now.
History- TBI, hypothyroidism, denies any other.
States he has had these episodes on and off over the past year and a half, has lost a significant amount of weight (100lbs), and has been seen a few times and the hospital "doesn't do anything to fix it."
Meds- Trazodone, Gabapentin, Bupropion, Disulfiram, Levothyroxine. Pill counts are estimated but appear correct for prescription dates.
Vitals on scene
BP 160/100
HR 50
98% room air
RR 16
Lungs clear all fields
Pupils =/R
In the truck you notice the heart rate is 48-50. PT is lethargic but answers all questions appropriately. States his eyes are closed because he is "tired." 12 lead unremarkable - sinus brady.
IV is started, your partner gives 4mg zofran, 100mcg fentanyl, and hangs NS wide open. Normal traffic transport.
Enroute heart rate noted to be as low as 36, BP remains hypertensive, PT states pain is unchanged post Fentanyl. PT still alert and oriented.
What else do you want to know? What else do you want to do? What is included in your field impression/differential diagnoses?