1911 Beta

Any medically trained people on here? I have questions about a patient I had...

I'm Wilderness EMT certified but I haven't done that shit in years.

I'm a lifeguard instructor and wilderness first aid... not sure that will help you much

1911 medical advice.

I watch House M.D., what can I help you with?

Ill post the question anyway....

I had a patient yesterday post ercp with a significant cardiac and stroke history. She had a rt sided stroke in the 90s
I was doing a set of vitals upon return to her hospital when I noticed the pulse her stroke side was 40 bpm and her non-strokeradial pulse was 80 bpm. My partner and I both felt it so it wasn't me imagining things but I can't find anywhere on Google and no one can tell me what the physiology of 2 different pulse rates is. My last resort is 1911 but I guess I can track down a cardiologist if I have too. I don't know why I though 1911 would be a resource but you never knew.

Yeah that's really strange, could be Stenosis or something I guess? But still there isn't really any way that her actual pulse should be that different from one side of the body to the other, stroke or no stroke. A cardiologist would know what could cause that effect though I'm sure.

My first guess was stenosis but also could be artery occlusion? Her sats were quite a bit lower on that side. I started to sort because she was a sick lady and the original pulse was 40 and sat's 88...was like"are you sure you're feeling alright?" Lol

I'm not saying it aliens.... but, aliens.

PUNKYETi wrote: My last resort is 1911 but I guess I can track down a cardiologist if I have too. I don't know why I though 1911 would be a resource but you never knew.

+rep

Rambizzle wrote:I'm not saying it aliens.... but, aliens.

The answer, AAA or stenosis of the artery. Look it up.

i have a cousin whos a cardiologist, to bad you already figured it out. i coulda been useful maybe.

I am EMT-B certified, among other little things.



EDIT: For clarification purposes, EMT-B recently changed to EMT due to new legislation at the beginning of the year.

TOO LATE JOHN, YOUR GLORY HAS BEEN DE_NIED.

Did you do a cap refill on either side? Also, the patient isn't vented, right?

No. She had an old stroke so her BP on either side was all over the place anyways.

I would say based on her cardiac history she was def a stenosis.

Capillary refill would be an excellent way to check for perfusion, but did you check her pulse at her brachial artery? Its been forever since i have done clinical, due to the demographics of who i deal with.

I did NIBP on both arms. On our LP15 it gives us a pulse when it captures the bp, it was 40 on the left, 80 on the right so its safe to assume her brachial is the same and radial.

This is from one of my physician clients who i happened to be meeting with today:

It is highly unlikely to be something like AAA (too distal to cause the s/s in this patient). Stenosis is a possibility or some kind of involvement of the aortic root/arch. More likely might be an interesting presentation of peripheral vascular disease (think horses, not zebras). Knowing the exact difference in blood pressure could be useful. Additionally, prior surgical history, especially in the affected arm, could also be useful (for example, it is possible that the patient has had the radial artery removed and the pulse/bp was diminished as a result... I saw a patient who had this procedure performed for some kind of cardiac revascularization procedure). It is difficult to construct a clear differential based on the history and exam provided... other information like lower extremity pulses, JVP, cardiac exam (rate, normal S1/S2, presence of S3/S4, size/location of PMI, etc.) may be helpful along with a pulmonary exam.

I wish I had had time to do a full head to toe assessment but we arrived at the hospital too quickly.

AAA was out for so many reasons, just came up in my discussion with the thoracic surgeon as a potential cause.

BPs were 130/70 something on the right, 80/60 something on the stroke/affected side.

Personally, if I don't have to, I don't touch feel for pedal pulses on stable non-trauma patients lol

Is it lupus?

likwid wrote:Is it lupus?

Ok let's change to my recent symptoms and see what ideas to come up with.

So my left eye, bottom eye lid, has been spazzing out frequently for about 2 weeks now. This spazzing consists of a quick rapid pulse throbbing my eye lid. It isn't painful but it's annoying and blurs my vision do to the lid pulsing. All I do is press upon my lid and it suppresses it.

This has happened for years but usually like once every couple of months but now it's just getting annoying.

Ideas?

AlopeX wrote:Ok let's change to my recent symptoms and see what ideas to come up with.

So my left eye, bottom eye lid, has been spazzing out frequently for about 2 weeks now. This spazzing consists of a quick rapid pulse throbbing my eye lid. It isn't painful but it's annoying and blurs my vision do to the lid pulsing. All I do is press upon my lid and it suppresses it.

This has happened for years but usually like once every couple of months but now it's just getting annoying.

Ideas?

Holy shit! I have the same damn thing but it's only happened a handful of times in my life. It usually lasts a few days, but is definitely annoying as hell! What's creepy is that it's my left lower eyelid as well, no homo.

AlopeX wrote:Ok let's change to my recent symptoms and see what ideas to come up with.

So my left eye, bottom eye lid, has been spazzing out frequently for about 2 weeks now. This spazzing consists of a quick rapid pulse throbbing my eye lid. It isn't painful but it's annoying and blurs my vision do to the lid pulsing. All I do is press upon my lid and it suppresses it.

This has happened for years but usually like once every couple of months but now it's just getting annoying.

Ideas?

That happens when your eyes are strained, I'm guessing you either haven't had enough sleep or you've been staring at a screen for too long (or both).

Makes sense; I was working third shift with little sleep at those times.

gwolf_ wrote:That happens when your eyes are strained, I'm guessing you either haven't had enough sleep or you've been staring at a screen for too long (or both).

That was always my theory too but it has persisted through me getting a ton of sleep and being off my pc. Guess my eyes didn't get the memo.