Question for you seasoned vets out there.

[EMTStudentwa]

I remember my buddy saying something about finding someone super intoxicated, unconcious with jaundice skin. Now going through my EMT class, I was compelled to try and read up on what (some what acute)jaundice skin can be an indicator of. But, I dindnt really find anything in my textbook about that. See my goal is to not just identify the major problems(SOB, cx px, altered LOC, etc...) but those funky, somethings not right signs where a sort of privy extended knowlege can give me a better idea of what kind of patient I'm dealing with. I understand its obviously not my job, nor in my scope of practice to id and treat these issues but, id like to be able to have an idea rather than be like "duh, I dunno, I have zero clue what's going on with you". I know it will happen but I want to be as prepared as I can be.
Thoughts, stories, reasoning?

 

[JPINFV]

The answer is fairly simple actually. Alcohol causes liver damage. The liver is the primary sites for metabolizing and secreting hemoglobin (the other site for last part of metabolism as well as excretion is the kidneys, and a fun fact is the byproducts of heme metabolism is what makes urine yellow and feces brown) and when it can't do so the byproducts get deposited everywhere, including the skin. Hence people with decreased liver function can develop yellow skin (jaundice). Babies with liver problems get the deposits in their brain, which is called kernicterus.

I understand its obviously not my job, nor in my scope of practice to id and treat these issues but, id like to be able to have an idea rather than be like "duh, I dunno, I have zero clue what's going on with you". I know it will happen but I want to be as prepared as I can be.
Thoughts, stories, reasoning?

Actually, it very much is your job to form a diagnosis. You might not be able to treat it, but how would you know if something is going on that you can treat if you can't ID the problem?


As an aside, this is the advantage of running a blog. I don't have to type out a long commentary on EMS and diagnosis now, just plop a link in.

 

[EMSLaw]

Technically speaking, jaundice is an indication of an unusually high level of bilirubin in the bloodstream. While there are numerous possible causes of jaundice, the classic one is liver disease, including (...wait for it...) alcoholic liver disease.

So, if your patient is dead drunk, and jaundiced, it's entirely possible you can draw from this that they are a heavy, habitual drinker who now has a serious liver problem. Or they could have hepatitis. Or lots of other things.

 

[EMTStudentwa]

JPIN, thanks for the info, its nice to really get the info I'm looking for. If anyone else has more to add or stories to tell, please do.

 

[Aidey]

You could also have someone dying of pancreatic cancer who decided to go out and have one last hurrah.

Jaundice is actually a pretty hard symptom to diagnose the cause of prehospitally, due to the number of causes. Essentially the only way you are going to know for sure what is causing it is if the patient already knows. In the more obvious cases you can make an educated guess that will probably be right, but it still has to be confirmed by a blood test.

The best thing you can do is make sure you recognize jaundice and report it to your partner or the hospital. Also be aware that someone with jaundice is likely sick, even if they might not look that bad.

Gallstones can be another cause of jaundice, if they block the right spot. If someone with gallstones develops jaundice it is considered an indication that the time has come for surgery. I ended up with gallstone pancreatitis earlier this year, and went from being pink to the color of a banana in 2 1/2 days. I was so miserable and doped up (opiates + promethazine) I didn't even notice until it was pointed out at the hospital.

 

[Akulahawk]

Jaundice is one of those signs that indicates that there's an abnormally high level of bilirubin in the blood. The problem is that there's more than one or two things that cause elevated levels of bilirubin. As JP indicates, the liver is implicated a lot in jaundice. One of the more interesting things is seeing someone whose skin and sclera look orange and they're in liver failure. There's an interesting odor with that... and I'll never forget it.

A place to start is here: http://www.medicinenet.com/jaundice/article.htm

 

[DaintyFlight]

Speaking of Q's

I totally got this question wrong :sad: because I wasn't paying attention



Trendelenburg's position is MOST accurately defined as a:

Supine position with the legs elevated approximately 6" to 12".

Supine position with the legs elevated 6" to 12" higher than the head.


this book is a sneak snake....full of trickery

In response to the lead poster guy I would think Liver issues depending on more details.. are you taking a test?if so does it state he has pain in the right side? maybe he is just a hypercondreact HA HA B)

 

[Aidey]

Trendelenburg's position is MOST accurately defined as a:

A pointless practice instituted by a surgeon in the 1880's that has continued without any scientific proof of effectiveness in increasing cerebral perfusion.