need advice

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emtbdoleshal

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i was on a call today and had a 21 year old female complaining of hot stomach dizziness nauseau when sitting cold body achy feeling missed period and cramping going to hunger pains she ate something and the nauseau didnt go away her blood pressure was 126 over 78 pulse was 74 and respirations were 24 with periods of feeling her blood pulsing through her right arm left arm and stomache her pupils were completely reactive and normal she had a headache on the right temple and when i shined the penlight in her eyes the headache went to both sides i was wondering if anybody could give me advice on what it could be. i am some what stumped do to the fact that i was not able to see any further tests and the confidential info she gave me is pointing me towards she is pregnant i would love to hear other peoples opinions especially any experianced emts.
 
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emsunit37

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what was her temp? where did the pain start and what did her pain feel like to her did it radiate anywhere?
 
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Amber

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Just based off the info ya told me, and my past experience in OB, sounds like she could be pregnant, also that it maybe an ectopic. But as far as based on EMT knowledge, I'm just a student, :)
 
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emtech419

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It doesn't sound ectopic to me. If she is pregnant, depending on how far along she is (patients don't always know), it does sound like she's starting to become pre-clamptic. I would like to know what her temp is, and where her pain specifically is located, since this could also be just gastroenteritis.
 
mycrofft

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Nothing you can do anything about as an EMT.

VS and incomplete objective exam normal, all c/o. With abd c/o and hx of missed period and suspects pregnancy (find out how late maybe; but since this will not impact your tx don't get too personal), she needs to see a doc.

Differential could be many things or a combination, from hysteria or Munchhuasen's or seeking drugs for migraine without anti-emetics, to food poisoning or even incipient "STAT belly", but whenever there's a belly involved and possible pregnancy, I'm sure all involved will appreciate an MD's appraisal instead of EMT's holding their chins and shotgunning questions in the living room.

I'm not seeing her belly sounds, either auscultaive or percussive, nor a palpation. Also not seeing history of meals and toilet for last 24 hrs or more.

So, what did you do with this...or are you en route now?;)

EDIT: PS, I have been accused of being elitist here. This reply is said with wry humor and memories of some of my earlier runs.
 
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Amber

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emtech419 said:
It doesn't sound ectopic to me. If she is pregnant, depending on how far along she is (patients don't always know), it does sound like she's starting to become pre-clamptic. I would like to know what her temp is, and where her pain specifically is located, since this could also be just gastroenteritis.
Click to expand...

The reason I said etopic is right before rupture, a woman can have fevers as well as just general pain. Its not atypical, infact during my etopic as well as many pts I have worked with show these types of sympotims. If it was pre e she would have to have been 20 weeks or greater from my understanding, and a 20 week pregnancy would most likely to be able to be palpated, depending onif the pt was extremly obese of course.

Sorry for any spelling errors I'm typing this on my phone :)
 
mycrofft

mycrofft

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No temp recorded. Do EMT's do them?

I just realized that very few EMT-B postings include temperature (or bowels sounds/palpation).
 
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emtech419

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Ectopic anywhere near rupture would see a distinct rise in heart rate, as well as a sharp pain (as opposed to the crampy pain described). Certainly not out of the question, but the problem with this, as with all acute abdomens, is the massive differential makes it pretty much impossible to monday morning quarterback.
 
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DesertMedic66

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mycrofft said:
I just realized that very few EMT-B postings include temperature (or bowels sounds/palpation).
Click to expand...

For my area EMTs and medics do not do temperature or bowel sounds.
 
usafmedic45

usafmedic45

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it does sound like she's starting to become pre-clamptic.
Click to expand...

What the heck makes you say that?
 
dixie_flatline

dixie_flatline

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usafmedic45 said:
What the heck makes you say that?
Click to expand...

Agreed - her BP is nowhere near what I would consider high enough. No mention of swelling either.

I have noticed that, in addition to all females of breeding age being considered pregnant until proven otherwise, many/most EMS providers likewise consider all pregnant women pre-eclamptic, regardless of actual pathophysiology.
 
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MrBrown

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Quick get Brown a large kitchen knife, its time for an emergency ex lap on the dining room table!

It could be any one of 400 things, put patient on stretcher and take to hospital
 
usafmedic45

usafmedic45

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usafmedic45

usafmedic45

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Can I just be promoted then? LOL
 
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usalsfyre

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Ever notice the newer you are, the more "oh my God emergent!!" things seem? ;)

Seriously, you've got a young female with a wide constellation of symptoms but who otherwise seems stable. The list of differentials is longer than an Illinois governor's rap sheet. Take her to the ED (probably ED triage at that).
 
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