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  • calling all Dr's

    my uncle has been in a lot of pain the last week. he has been to the Azle hospital and spent the night in Harris downtown Fort worth hospital and is now back at the Azle hospital.In Harris downtown they did cat scan drew blood but his oxygen level drops to something like 70. Im thinking possible blockage or a bleed in his brain. when he sits up and when he stands up he is really dizzy he has now gotten to a point where he has to lay flat on his back. his entire body is red like a sunburn and is on fire but he has no fever. a week ago he broke the tip end of his finger I don't know how significant that is but maybe an infection or something and the real frustrating part is every Dr. and nurse that came in the room at Harris he told them about his finger and they said oh well we knew nothing about your finger. and still no one knows whats wrong with him

  • #2
    Get another opinion. If his oxygen saturation is 70% on inspired air, he's not adequately perfusing. This could be due to a variety of reasons. The red face could be due to hypertension, medications, anaphylaxis, etc, etc....What were the radiology results on the CT? What his CBC normal (probably not with a sat of 70)? Did they discuss it with you? What medications is he taking? Was this a sudden or progressive onset of symptoms? History and any existing medical conditions like COPD, Asthma, etc..?

    If he had a brain bleed he would probably be quite incoherent/disoriented/worse headache of his life or show other serious cognitive symptoms. I'm sure the medical staff would have been able to catch that even upon a basic head to toe physical and nuero exam.

    Too many variables to give you any real insight. I suggest you keep getting second and third opinions until you find someone that can give you a definitive diagnosis. There is nothing anyone can do for you over the internet other than ask a lot of questions that you probably don't know the answer to. Good luck. And be persistent with finding him competent medical care.
    Last edited by LS1Goat; 12-01-2010, 10:53 PM.

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    • #3
      Originally posted by Mustangman_2000 View Post
      Get another opinion. If his oxygen saturation is 70% on inspired air, he's not adequately perfusing. This could be due to a variety of reasons. The red face could be due to hypertension, medications, anaphylaxis, etc, etc....What were the radiology results on the CT? What his CBC normal (probably not with a sat of 70)? Did they discuss it with you? What medications is he taking? Was this a sudden or progressive onset of symptoms? History and any existing medical conditions like COPD, Asthma, etc..?

      If he had a brain bleed he would probably be quite incoherent/disoriented/worse headache of his life or show other serious cognitive symptoms. I'm sure the medical staff would have been able to catch that even upon a basic head to toe physical and nuero exam.

      Too many variables to give you any real insight. I suggest you keep getting second and third opinions until you find someone that can give you a definitive diagnosis. There is nothing anyone can do for you over the internet other than ask a lot of questions that you probably don't know the answer to. Good luck. And be persistent with finding him competent medical care.
      they said they couldn't find anything on the ct scan and he did say he had a really bad headache he is not taking any meds besides the pain meds they were giving him in the hospital oh and I forgot to mention his entire left side of his body is numb and its not just his face thats red its his entire body

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      • #4
        Orthostatic hypotension by volume depletion? Is he dehydrated?

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        • #5
          no he actually got a bag of fluids last night at harris

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          • #6
            Originally posted by krazy kris View Post
            they said they couldn't find anything on the ct scan and he did say he had a really bad headache he is not taking any meds besides the pain meds they were giving him in the hospital oh and I forgot to mention his entire left side of his body is numb and its not just his face thats red its his entire body
            if the radiologist said the ct scan was negative, then you can rule out the things you were speculating above. again, very difficult other than to take guesses without an exam/history/etc...

            could be an allergy. could be hypertensive crisis. could be something called a transient ischemic attack, which can mimic symptoms of a stroke. could be a psychological and not a somatic issue. etc...

            with a negative head ct and normal cbc results, i'm going to use occam's razor.....it's probably something most likely relatively benign that is causing uncomfortable symptoms or an allergic reaction to an allergen that is idiopathic (undefined/unknown). i also strongly feel they would not have discharged him with SATS of 70% without identifying the cause. if his dizziness occurs only during a change from being flat to an upright position, it's called orthostatic hypotention and has many many causes. some people taking drugs like beta blockers or antidepressants, will cause such symptoms. sounds to me like the guy needs a echocardiogram and a stress test to see if his heart is keeping up with the demands of his body as he exerts himself. and rule out any cardiovascular concerns.

            HOWEVER, the best course of action is to take your radiology and blood test results and consult another physician to get a second opinion.
            Last edited by LS1Goat; 12-02-2010, 12:05 AM.

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            • #7
              Originally posted by Mustangman_2000 View Post
              if the radiologist said the ct scan was negative, then you can rule out the things you were speculating above. again, very difficult other than to take guesses without an exam/history/etc...

              could be an allergy. could be hypertensive crisis. could be something called a transient ischemic attack, which can mimic symptoms of a stroke. could be a psychological and not a somatic issue.

              with a negative head ct and normal cbc results, i'm going to use occam's razor.....it's probably something most likely relatively benign that is causing uncomfortable symptoms or an allergic reaction to an allergen that is idiopathic (undefined/unknown). i also strongly feel they would not have discharged him with SATS of 70% without identifying the cause. if his dizziness occurs only during a change from being flat to an upright position. it's called orthostatic hypotention and has many many causes. some people taking drugs like beta blockers or antidepressants, will cause such symptoms. sounds to me like the guy needs a echocardiogram and a stress test to see if his heart is keeping up the demands of his body as he exerts himself. and rule out any cardiovascular concerns.

              HOWEVER, the best course of action is to take your radiology and blood test results and consult another physician to get a second opinion.
              Thank you I really appreciate all the info

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              • #8
                Hard to make an educated guess without doing my own history, physical exam and workup. There are many things that can cause his symptoms and it may not be just one thing causing it. It sounds like he got a CT and some bloodwork. You know the results? His finger injury isnt causing this. Please list all of his symptoms. After the obvious stuff is ruled out, stuff like serotonin syndrime, carcinoid syndrome and lyme disease need to be considered. If it were my family member, I would have him transfered to a university hospital.

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                • #9
                  Tim, a negative noncontrast CT doesnt completely rule out ischemic CVA. And your assumptions about a patient having negative labs and head CT means its a benign process tells me you should stick to what you know...ACLS/BLS. Googling stuff and reading it on the net and then trying to extrapolate the info based on your paramedic experience isnt sufficient. Youre a smart guy, but you are talking out your ass again. You need to carry your ass to medical school.

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                  • #10
                    they just did an ultrasound and he has a bad prostate infection and now they are going to do a ct scan on his back and stomach

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                    • #11
                      Prostatitis can be bad and can cause sepsis. He is probably in septic shock and the info you have about his workup is incorrect. But, he is at the hospital where they should eventually figure it out. Mentally masturbating on here isnt gonna help him. Post up data like lab results, blood pressure, temp, O2 sats, etc if you get/know them. Also post updates so we can see what they find. I hope the infection hasnt spread to his CNS.

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                      • #12
                        Originally posted by davbrucas View Post
                        Tim, a negative noncontrast CT doesnt completely rule out ischemic CVA. And your assumptions about a patient having negative labs and head CT means its a benign process tells me you should stick to what you know...ACLS/BLS. Googling stuff and reading it on the net and then trying to extrapolate the info based on your paramedic experience isnt sufficient. Youre a smart guy, but you are talking out your ass again. You need to carry your ass to medical school.
                        Here we go again with the Googling remarks. It's not like I didn't practically live at Parkland, Methodist, John Peter Smith, and Denton Community/Regional for a couple of years during my clinical rotations. I couldn't have possible picked up any additional info that exceeded the scope of my Paramedic training by spending countless 12 hour shifts with ER physicians, especially Trauma rotations at a Level 1 facility. Anyways...

                        However, I am mistaken and Dave made an excellent point about the non contrast CT. I apologize for making that assumption. I've never not had a contrast CT or MRI, so it was a capricious assumption on my part. Dave will be able to give you the best insight here being an M.D. And probably will tell you what I stated as well. Nothing definitive can be determined in this fashion, only suggestions and/or advice.

                        I hope your Uncle gets well. Take care.

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                        • #13
                          Yup. Main thing is we hope they get it figured out and your uncle gets back to his normal life.

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                          • #14
                            The azle hospital said he has a prostate infection and a bulging disc in his back, but this is also a place where I went with appendicitis and they prescribed me some pain meds and told me to go home.

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                            • #15
                              Did he get a flu shot recently?

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