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Case #42 Football Player Collapses


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#41 RoadieRN

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Posted 08 August 2008 - 09:57 PM

Hey all, just a thought, this player was described as a "Big boy"....Is he big as in body weight, or is he big as in muscle built....if its muscle, and this is just a side thought...is there a chemical floating around in the body that might have triggered something...A chemical that might cause muscle mass to build quickly....

I think our friend here might be on to something....
If he using 'roids or something similar, then he is at risk for cardiac and hepatic things that could cause his neuro status change, hypertension, and tachycardia. He could be having a MI. The cause of pneumo is pretty puzzling to me. It makes me wonder what else is he using in addition to the likely 'roids. HGH, lords knows what else.
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Nick Crusius RN, BSN

Keep the rubber(or skid, if it applies) side down!

#42 launchpad

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Posted 09 August 2008 - 12:30 AM

why does everybody consider 6foot 200 pounds big???????????????
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#43 LWTRF14

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Posted 09 August 2008 - 01:44 PM

why does everybody consider 6foot 200 pounds big???????????????


Yeah, 6 foot, 200 lbs may not be big....But the word "easily" makes my small light bulb come on and think he might be more. So for my own amusement I cruised around the cyber world and looked at the "doping" thing....First question about this patient...can we bounce a quarter off his chest and bi-ceps. If I am totaling off on this I think it might make a good topic somewhere else...The doping thing or use of Roids has a severe cardiac effects: Elevated BP, decreased high-density lipoprotein, erythrocytosis, myocardial hypertrophy, and thrombosis. I am from Florida, so if you guys could hurry up and figure this out and save this guy, we can get him drafted to the Dolphins....we need the help.
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Earl F Bakke III, NR-EMT-P, CC-EMT-P, PNCCT

#44 coloradoclimb

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Posted 10 August 2008 - 04:13 AM

This guy took a hit. Somebody should be saying by now what happened over the course of the practice. It could have happened some amount of time before the collapse and he appeared to be fine, confusing the coach's/player's analysis of the event. His HTN was being masked and now that the needle decompression has fixed one problem, we're seeing the next.... head injury. He's still confused and is having secondary HTN. C-spine for sure. Get more info! I have to think that is invaluable at this point. Watch the fluids...
I'm really new to this and am coming at it from an ICU standpoint for now. Start my new career as a flight nurse on Monday. Wooo hooo!
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#45 Mike MacKinnon

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Posted 10 August 2008 - 12:25 PM

hey all i havent forgotten about the case, im at a conference in Minneapolis and will get home on the 14, so we will continue then!
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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#46 LWTRF14

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Posted 10 August 2008 - 02:41 PM

This guy took a hit. Somebody should be saying by now what happened over the course of the practice. It could have happened some amount of time before the collapse and he appeared to be fine, confusing the coach's/player's analysis of the event. His HTN was being masked and now that the needle decompression has fixed one problem, we're seeing the next.... head injury. He's still confused and is having secondary HTN. C-spine for sure. Get more info! I have to think that is invaluable at this point. Watch the fluids...
I'm really new to this and am coming at it from an ICU standpoint for now. Start my new career as a flight nurse on Monday. Wooo hooo!



I am not so sure he took a hit at the point he went down. Let's get the sports medicine guy from the sideline and chat with him...theres always one around at HS football. Did this kid have all his gear on when the crew landed. He has the HTN, but that HR is up too >sympathetic response. HR is up, decreasing the filling time, so that may cause the confusion....Whats the temp out side and what quarter are they in...? Another odd question that comes to mind, how long as he been in the game...Take a look at the pupils and then point blank try and chat with this kid....go through the SAMPLE and be stern with the patient about any "stuff" he might have taken...I think now that the chest is fixed, lets get back to basics and re-assess from square one....
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Earl F Bakke III, NR-EMT-P, CC-EMT-P, PNCCT

#47 MSDeltaFlt

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Posted 10 August 2008 - 03:33 PM

I am not so sure he took a hit at the point he went down. Let's get the sports medicine guy from the sideline and chat with him...theres always one around at HS football. Did this kid have all his gear on when the crew landed. He has the HTN, but that HR is up too >sympathetic response. HR is up, decreasing the filling time, so that may cause the confusion....Whats the temp out side and what quarter are they in...? Another odd question that comes to mind, how long as he been in the game...Take a look at the pupils and then point blank try and chat with this kid....go through the SAMPLE and be stern with the patient about any "stuff" he might have taken...I think now that the chest is fixed, lets get back to basics and re-assess from square one....


Sports medicine guy?!? Not where I went to HS. All we had back then were a couple of basics on a sick wagon right outside the endzone chain smokin' Marlboro reds munchin' on some cheetos. ;)
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#48 Speed

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Posted 10 August 2008 - 05:35 PM

I was a student athletic health trainer for the last three years in high school and three semesters in college. While in high school I had a medical director and pretty much EMT-B equipment, plus a bunch of other stuff specific to sports medicine. Other things I did have that were a big help in a crisis were treatment consent forms signed by the parents for EMS and ER personnel, contacts, and most importantly their entire medical history. I will admit that during practices I wasn't on the field (sitting in an office under the AC, and clueless as to what disasters were going on outside), but there's a lot of info there if you ask. Usually there were a couple of air headed chicks helping out with water bottles, equipment, and trying to get laid. Usually not the ones to talk to for any type of credible answers.
One thing that I'm thinking with this guy is that a lot of the time when someone gets a significant injury in sports they were either not in the "right spot" (play position) or paying attention to what they were doing (no defensive posture or standing there with a 1000 yd stare). This "lack of postural defense" that resulted in getting a big blow to a venerable area could be a sign that the victim had an altered mental status prior to the traumatic injury?
I can remember on away games scoping out and "sizing up" the local EMS squads. Yeah sometimes you got the lard-ass Cheeto munchers, but sometimes there were some hotties on those trucks. Luck of the draw.
While we're waiting on MacKinnon, is there anybody else out there who did this in high school? Cramer student trainer program? Student trainer camp at Ole' Miss?
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Mike Williams CCEMT-P/FP-C

#49 fiznat

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Posted 10 August 2008 - 06:17 PM

The original post says that "all of a sudden" this patient collapsed on the field. I'm not sure if that means he got hit and stayed down or if he simply collapsed on his own (maybe a few minutes following a big hit?). It seems like the latter, although I think we'd definitely need clarification on that from the witnesses available.

Otherwise we now have a patient with AMS who recently had an (atraumatic?) pneumo. Might as well run though the routine AMS stuff again (ie. Tox/Metabolic/Structural/Infection/Psych). For now let's find out if there was any witnessed seizure activity, look for incontinence, check the sugar, inquire about drugs/possible tox, and do a stroke scale as able.

What is our patient's GCS?
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#50 JPatterson

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Posted 11 August 2008 - 01:36 PM

History is a MUST. We need to know anything that could have caused the pneumo and AMS. I would really like a 12 lead to look for tamponade changes (flipped T's, ST up/down) and re-assess for JVD, Heart sounds, etc. We also have to consider a closed head injury causing increasing B/P (not yet causing bradycardia) How are his pupils, neuro exam?

I may have missed it, but what is the temperature/humidity out? hydration status?
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Jeff Patterson NREMT-P

#51 Speed

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Posted 15 August 2008 - 01:56 AM

OK, so we're still standing out on this football field; lights out, everybody's gone home and all I hear are crickets chirping? Should we start diggin' a hole or what Mikey boy?
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Mike Williams CCEMT-P/FP-C

#52 MSDeltaFlt

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Posted 15 August 2008 - 12:07 PM

OK, so we're still standing out on this football field; lights out, everybody's gone home and all I hear are crickets chirping? Should we start diggin' a hole or what Mikey boy?


I'm with you, Mike. Once we've treated the immediate life-threats, we are to follow the American College of Surgeons' guidelines and transport to the closest appropriate facility; a level I trauma center.
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#53 LWTRF14

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Posted 15 August 2008 - 02:44 PM

Hey, while were in limbo, I am going to run over to the concession stand and grab a hot dog....anybody want anything? (Just kidding around).
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Earl F Bakke III, NR-EMT-P, CC-EMT-P, PNCCT

#54 Speed

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Posted 15 August 2008 - 03:01 PM

Just a request for the band. Queen, "Another One Bites the Dust". Thanks.
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Mike Williams CCEMT-P/FP-C

#55 MSDeltaFlt

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Posted 15 August 2008 - 03:56 PM

Just a request for the band. Queen, "Another One Bites the Dust". Thanks.


My favorite Queen piece is "Fat-bottomed Girls"
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#56 fiznat

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Posted 15 August 2008 - 11:37 PM

ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ
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#57 RoadieRN

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Posted 16 August 2008 - 03:19 AM

Bueller?... Bueller?... Bueller?


:lol:
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Nick Crusius RN, BSN

Keep the rubber(or skid, if it applies) side down!

#58 Mike MacKinnon

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Posted 16 August 2008 - 12:27 PM

LOL

You guys are killin me :P


Ok, now that im recovered from conference debauchery...


With the pneumo decompressed and a patient who is now still confused and hypertensive what are the differentials?

BTW, he has a seizure as your moving him to the board and during it a bottle rolls out of his jack "Rip Fuel with Ephedrine"

BP: 220/130
HR: 115
RR: 22
Sat: 98 NRM
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Mike MacKinnon MSN CRNA
WWW.NURSE-ANESTHESIA.ORG

"What gets us into trouble is not what we don't know
It's what we know for sure that just ain't so" - Mark Twain

#59 MSDeltaFlt

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Posted 16 August 2008 - 01:21 PM

Protect the airway. Put him down and tube him, but lay off the paralytics. You can't mask any Sz activity. By doing so, expect to give a TRUCK LOAD of benzos. If we don't get that BP under control, he'll keep on seizing and/or have a stroke in the process. If the benzos won't get the BP in the target range, then some labetalol can help. Don't do it fast. You don't want much. 10 maybe 20mg IF and ONLY IF the benzos can't do it.
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#60 medic093

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Posted 16 August 2008 - 01:44 PM

I agree with MS, airway protection is key right now. The Hypertension def. something that needs to be controlled. I question the kid's medical history though...the no medical hx that mike states...is this meaning he has no PMH, or we don't know? Wondering if maybe the ephedrine is being inadvertantly (or intentionally) mixed with some psych meds ( SNRI's or NDRI's) and we're dealing with increased serum norepi levels. was this kid taking some friends meds for its stimulant effects and just happened to have these effects?
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