FAO Sqad

[bobjugs12]

Any ideas because she had myself and my crewmate stumped:
65yo fem.
Confused and unsteady. GCS 12. Left sided facial weakness and left pupil blown. Complaining of blindness in left eye.
She was tachy at 130(ish), bp was slightly high (140/90approx) and pyrexic at 39.7deg.
She also had resps of 30+, was coughing, wheezing and had audible crackles. 02 saturation at 86% on air.

My theory is that that she possibly has several different things wrong and has capped it all off with a CVA. My crewmate agress. A+E think Sepsis and Swine Flu, but are CTing her as well.

What do you reckon?

[Sqad]

Sudden onset?
Left sided weakness.....upper motor neurone or lower motor neurone? IMPORTANT.
PMH?
Medications?
Weakness in arms or legs?

[bobjugs12]

PMH - only PMH known was epilepsy. Only meds we could find were linked to the epilepsy. We couldn't get anything else out of her. She kept asking if we were going to take blood because she likes to watch it happen (she told us this about a dozen times)
No idea if it was sudden or prolonged. Went asking neighbours for help and discovered a street where the total IQ was still lower than my shoe size.
No obvious weakness in limbs during a FAST test, but again she wouldn't answer any questions although she did obey commands.

[Sqad]

bob....facial palsy....upper motor neurone or lower motor neurone? this is CRITICAL

upper motor neurone includes the face muscles ONLY
lower motor neurone involves the face AND the eye muscles.

lower motor neurone would suggest a lesion from the stylomastoid canal to the face.
upper motor neurone lesion is within the brain.

This may be confusing but is essential in diagnosis....so learn it.

Now which is it LMN or UMN?

[bobjugs12]

Sqad, we wouldn't try and diagnose that en-route. She was very much a 'load and go', and to be honest we were expecting an arrest in the back of the truck as well due to her very poorly state. The O2 sats didn't come up past 92% even on high-flow oxygen (for a non-smoker with no obvious COPD!) and her HR never lowered.
I would think though based on your description of the muscles affected then it's gonna be lower motor neurone.

[Sqad]

LOL...bob...sorry I "roughed you up a bit".....but you have peoples lives in your hand and anyway I am proud of you............I will rough you up again if I think necessary ( it wont do you any harm;-)

I agree with you and your mate.......I think that she has an acute chest infection followed by a CVA...........well done mate.....let me know the outcome.

In the meantime take time off from sh@gging NoM and read up about the 7th cranial nerve....it will haunt you for the rest of your life.

[bobjugs12]

Lol sqad. Unfortunately NoM has returned home for New Years as i'm anticipating a night involving lots of vomit, booze and drugs (shame, none of its mine!!)
However i'll look into the 7th Cranial nerve (god I hate the nervous system)