How to find out about possible infectious diseases

[seanm028]

Hey everyone. Today a person passed out as I was walking by, so I called 911 and got a SAMPLE history, tried to get details about the events leading up to it (since it seemed like he might have had a Sz) and basically just tried to keep him (and his friends) calm until intervention arrived.

However, the more I think about it, the more worried I get. His signs/symptoms were not consistent with "standard" illnesses that normally cause people to experience syncope (very pale/ashen color at first, diaphoresis, incontinence to urine, supposedly Hx of blood in stool for past 2 days, etc. No known allergies, no medications, not diabetic) which is making me worried about meningitis or something else (we're in a college dorm). However, with HIPPA, it's not exactly easy to find out if he tests positive for something. Since I am a certified EMT and I was first on scene, is there some sort of a loophole or something that will allow me to at least find out if I'm at risk for anything?

 

[ffemt8978]

If you have a documented exposure, as defined by federal/state law, you can find out under the Ryan White Act. But for general exposure (except in the case of infectious tuberculosis), this law does not apply. That is why PPE/BSI is so important in our business.

 

[Ridryder911]

Couple of things:

Did you get exposed, such as blood, mucus, droplets, body fluids? If no, you had no exposure.

Wash your hands and removed exposed clothing afterwards?

Syncope can be caused by thousands of problems, most are non- communicable. If you are still worried, contact the ER Mgr, explain the problem and they should be able to direct you to the appropriate person.

R/r 911

 

[seanm028]

When I first got there, I didn't have gloves, but I don't think I touched him. I tried talking to him, I think I pulled his hood off his face, and I called 911. Then I went and got gloves, and started the physical part of the exam (checked pupils, tried to get a pulse/BP but was UTO due to heavy clothing, noticed diaphoresis). And afterwards, I washed my hands and used alcohol-based disinfectant. I guess I'm alright, it's just the paranoia in me coming out.

Unfortunately I was not on duty at the time, just passing by. So I don't think I can document anything. Not to mention, I wasn't exposed to any fluids (except for a little sweat on my gloves).

 

[Ridryder911]

Personally, IMHO I would not be worried. As I described, if you are concerned, then take action.

p.s. Those s/s are actually the "norm" of syncope. Vasovagal, even hemorrhagic shock (good indicator) especially with history of blood in the stools. Chances are he was "tilt positive" that he was low and became symptomatic.

R/r 911

 

[seanm028]

Thanks for the info. I didn't think those were common S/S, I was thinking they were closer to postictal S/S if anything else but that's good to know.

It was definitely a good learning experience though. I was able to watch him go from "awake" but AOx0 with pale skin to AOx4 with normal color, and all the stages in between.

BTW, what is "tilt-positive"?

 

[Ridryder911]

Tilt + is referred to a test that is routinely performed from having the patient go from a supine position to a a vertical or standing position. Take the vital signs before (laying/supine position) then raise them up and allow one minute for compensation. If there is an increase of pulse by 10 & a decrease in blood pressure by 10 points, or if the patient is symptomatic (vertigo, dizzy, diaphoretic, etc) then one would consider this as tilt +. This is usually, indicative they have lost interstitial fluid (dehydration) approximately 500 ml/1 liter or more, or at least a unit of blood. It is not an exact science, rather a good indicator.

Let me also add, anytime you have a patient that becomes diaphoretic, this is not just red flag, rather a FLARE! Be aware, this is an indicator there is something wrong, and a sympathetic response. The body warning symptom, it is NOT normal to break out in a cold sweat. Of course, this could be in response to anything, but a serious indicator.

R/r 911

 

[seanm028]

Update: Turns out he had a stomach ulcer that's been bleeding for the last 2-4 days. Received some transfusions in the hospital, he's recovering nicely now. Thanks for the input.

I have heard of the tilt-positive test but in our EMT class they called it "orthostatic vitals." I didn't know the general amounts that make it significant though, so I'm glad you told me that.

 

[wolfwyndd]

Yeah, really, thanks for that great description. I'd heard the symptomatic part before but never heard the 10 / 10 rule. Wow. I learned something new today. My goal in life.

 

[skyemt]

Rid,

if they were having a bradycardic episode, which caused the syncope, would they be tilt - ?

 

[wolfwyndd]

Considering that dizziness and fainting can be symptoms of bradycardia, I'd have to guess they would be tilt positive, not tilt negative. However, without a set of vitals before and after, it's just a guess. We can further add that dizziness and fainting are symptoms of a LOT of illnesses. So, after determining they were tilt positive, I DEFINATELY would not go, 'oh yeah, they're having a bradycardic episode.' That would be a h@ll of a jump to conclusions!