By: Jess Metlay, Captain, 2013
As EMTs we do not provide official diagnoses for our patients but in EMS care it is important to differentiate between call types. In this spirit, each month I’ll present a short scenario and either ask you to provide a treatment plan or tell me what’s wrong. So, without further ado…
You receive a dispatch on a Sunday afternoon for a 20 year old female patient with abdominal pain. Sounds simple enough. When you arrive on scene you find your patient sitting up on the sofa in her living room. Your patient arrived home yesterday morning for spring break. When you ask her to describe her pain, she tells you that she is actually feeling a lot better at the moment. The pain started two days during her last midterm with a mild pain by her bully button, which she originally attributed to nerves and a lack of sleep. However, that night she woke up to a sharp pain in her lower right abdomen and vomited. She reports experiencing waves of mild to moderate nausea since then. The pain persisted all throughout yesterday and even radiated to her back, “I spent all of yesterday lying in bed. Everything hurt: eating… drinking… moving. But by the far the worse was right after I accidentally pressed down on my abdomen.”
You perform a focused physical assessment by palpating the patient’s abdomen. Her lower right quadrant is extremely rigid; she even flinches when you apply pressure (“I guess the pain hasn’t really gone away”– patient). The rest of your physical exam is unremarkable and vitals are normal. Your patient does have a low grade fever of 100°F. The patient’s parents are also on scene and mention that she had a fever of 101°F yesterday, as well as the fact that she barely touched her dinner last night or breakfast this morning (“It was her favorite!”).
You are concerned about the continued rigidity and fever, so you ask some additional questions: “when did the pain get better?” and “did you take any medications or do anything in particular to improve the pain?”
“That’s the weirdest part” she says, “I woke up this morning to by far the absolute worst pain since this all started. It felt like I was being stabbed. I basically passed out from the pain and then when I came to, I told my parents and they called 911. But I actually feel a lot better now”
Not the answer you wanted to hear; immediately concerned, you rush her to the ER where she is scheduled for an emergency surgery.
What was wrong with your patient? Send your thoughts to firstname.lastname@example.org.
Congratulations to Sharon Lee for solving last month’s puzzle! Your EMS partner had hyperglycemia or high blood sugar. The question you asked was if he had diabetes (which he did). Left untreated hyperglycemia can develop in diabetic ketoacidosis, which is likely what happened to your partner.