90yof - csf?

[TreySpooner65]

Here is the scenerio:

I work as an EMT as an IL facility, licensed as an AL facility.

Resident walks into my office and asks us to check her ear. "If feels like moisture is leaking from it." So I inspected her ear. Indeed fluid was leaking; clear with an orange/pink tint. Large stain on her collar and shoulder from fluid. No battle signs. Other ear was dry and normal. No other complaints from patient. Eyes were not PEARL. Left was normal, reactive. Right was constricted and non reactive. Heart rate was 115. No other complaints. A/Ox4.

What would you do?

 

[TbArbie]

Well from what I have learned, I would apply a loose dressing by the ear to collect the leaking fluid, 15l 02 , cspine precautions to cover myself, transport...it sounds like a spontaneous csf leak which could have to do with something wrong in the sub arachnoid space

 

[Remeber343]

First I would ask what happened prior. Then I would see if there was a past history of this. I would then grab a piece of gauze and so that inaccurate halo test. I would also ask her if she has a glass eye or if her eyes are normally unequal. I wouldn't think it would just leak out all willy nilly. It could be just a small perforation in the ear drum or something. I would also ask her if she had any other complaints, headache/n/v. Anything else that is bother her.

15l 02 , cspine precautions to cover myself

Just curious, why the 15l o2? And why C-Spine?

 

[DrankTheKoolaid]

re

Get a history and Vs. Snicker as partner asked to do the novelty Halo test (though i always wanted to do it to a patient also early in my career) as i instead test it for glucose. Spinal precautions are not only not indicated but would actually be contraindicated with this patient causing increased ICP and faster leakage ICF if indeed it was. Standard treatment while enroute to ED. High fowlers position for transport, Vs, CM, IV for the incoming blood patch if she does infact have a csf leak and gets the typical headache. O2 is not indicated. Other then that have a nice chit chat while en route to ED.

 

[TreySpooner65]

First I would ask what happened prior. Then I would see if there was a past history of this. I would then grab a piece of gauze and so that inaccurate halo test. I would also ask her if she has a glass eye or if her eyes are normally unequal. I wouldn't think it would just leak out all willy nilly. It could be just a small perforation in the ear drum or something. I would also ask her if she had any other complaints, headache/n/v. Anything else that is bother her.

Halo test was inconclusive.

No headache, nausea, or vomiting. Patient has mild cognitive impairment. Denied any trauma/fall or further pain.

History of A-Fib. No other pertenant history. No ocular devices. Eyes are normally PEARL.

Keep in mind I do not work on an ambulance and we do not send off every patient to the ER. In this situation would you have initiated transport to ER?

 

[DrankTheKoolaid]

Yes, especially if the suspect fluid bgl is ~ half (f)bgl. And even if she flat refused ambulance transport i would spend plenty of time to convince her and or other caregivers to get her to a MD for further evaluation

 

[mycrofft]

Baseline pupils and which ear was it?
Orangish clear fluid could be a draining sebaceous gland or even en early staph infection.
Second the no O2 indicated by these factors. Why an IV?

 

[TreySpooner65]

Baseline pupils and which ear was it?
Orangish clear fluid could be a draining sebaceous gland or even en early staph infection.
Second the no O2 indicated by these factors. Why an IV?

Right ear, and right eye.

 

[mycrofft]

ANd large stain, so too big for abscess etc.. Get an otoscpe.

 

[DrankTheKoolaid]

Baseline pupils and which ear was it?
Orangish clear fluid could be a draining sebaceous gland or even en early staph infection.
Second the no O2 indicated by these factors. Why an IV?

Planning ahead for the labs i would draw blood for along with access for a (blood patch) which is the treatment for the headache patients get when they lose to much csf from lumbar punctures / csf drainage.

 

[Remeber343]

Im not thinking it's csf though. Could be a few things. Could be cause by a puncture from a q tip or whatever else they could fathom sticking in their ear. Could be swimmers ear, some sort of otaorrhea. The pupil change is interesting though... And she said no signs of trauma but how good of a historian can she be?

 

[TreySpooner65]

We did initiate transport to ER for that patient. Would you like me to tell you what the resolution was?

 

[Remeber343]

Sure what was the dx?

 

[TreySpooner65]

Pt was discharged from ER 2 hours later with a dx of an ear infection <_<

To me (granted, I'm just an EMT-B), that doesn't account for the pupils.

 

[TbArbie]

First I would ask what happened prior. Then I would see if there was a past history of this. I would then grab a piece of gauze and so that inaccurate halo test. I would also ask her if she has a glass eye or if her eyes are normally unequal. I wouldn't think it would just leak out all willy nilly. It could be just a small perforation in the ear drum or something. I would also ask her if she had any other complaints, headache/n/v. Anything else that is bother her.



Just curious, why the 15l o2? And why C-Spine?

O2 for comfort measures, and c-spine incase there had been past trauma and the pt doesn't remember or doesn't want to say.

 

[NomadicMedic]

O2 for comfort measures, and c-spine incase there had been past trauma and the pt doesn't remember or doesn't want to say.

Hmm. Most people aren't very comfortable with oxygen drying out their nares or a mask blasting in their face. How about you only use O2 for patients that clinically require it?

 

[TbArbie]

Hmm. Most people aren't very comfortable with oxygen drying out their nares or a mask blasting in their face. How about you only use O2 for patients that clinically require it?

Very true, I was taught always to administer o2

 

[Remeber343]

Typically, if they had some sort of traumatic injury that would cause csf to be present, you would either be able to visual the bruising. She is fairly old and frail. Also, if you palp around her head it could also reveal signs of a fx causing the fluid.

 

[Remeber343]

Very true, I was taught always to administer o2

And why the o2 though? I mean I know they taught you to do that, but what here would cause you to believe the patient needed to have o2? Just curious.

 

[epipusher]

Very true, I was taught always to administer o2

are you by any chance a firefighter?