jmj11 Posted May 23, 2012 Share Posted May 23, 2012 I don't know if you have watched Deadliest Catch on Discovery. I got interested when I found out that one of my patient's sons stars on it and one of the boats sometimes docks right outside my clinic window. Anyway, I don't know if you watched last night's episode but it was an medical emergency, requiring being airlifted. If you watched the whole episode, it was a classic medical case (if you play a little Sherlock Holmes). See if you can make the diagnoses: (if it doesn't embed go to this link) <iframe id="dit-video-embed" width="640" height="360" src="http://static.discoverymedia.com/videos/components/dsc/f65b80c32821500ca0524bc30278ed94a0acdad9/snag-it-player.html?auto=no" frameborder="0" scrolling="no" allowtransparency="true"></iframe> Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted May 23, 2012 Moderator Share Posted May 23, 2012 Hypernatremia? Link to comment Share on other sites More sharing options...
burnpac Posted May 23, 2012 Share Posted May 23, 2012 I'm a huge fan of DC, and I was thinking as I watched this that hyperventilation was one possible etiology for what appeared to be his carpal pedal spasming. One thing for certain, you had better be pretty good at first responder stuff as a boat captain on the Bering Sea as help is almost non-existent on a crab boat. Link to comment Share on other sites More sharing options...
jmj11 Posted May 23, 2012 Author Share Posted May 23, 2012 My take on it, and you may never know since I'm sure his providers aren't going to disclose to the public is Psychogenic Non-epileptic seizures. The reason I assume so is looking at the context (classic. Intense fear about a situation, yet being forced to stay in that situation) and the objective witness of the spell. In my previous life, having spent 20% of my time in epilepsy, I've seen many, many PNES in my office. Estimates are as many as 30% of new cases of seizures are PNES. So the spell he was mimicking was supposedly a generalized seizure, all limbs shaking and tonic, confusion and etc, yet he was talking as he was shaking (not possible in true GTCS). If you look at the exam by the captain ("how many fingers am I holding up") and he says "four." There is no human condition that would cause someone to say this except for a severe diplopia (which doesn't fit with his other signs and symptoms) or psychogenic pseudo-seizure. We will see. But I'm sure he will never admit it nor will it be fully disclosed. Just like on Gold Rush a kid had a seizure (a real seizure) and the men all claimed it was from drinking water with Raccoon feces in it so they go off into the woods to kill all the Raccoons. They even had a Portland Neurologist (out of context I'm sure) saying "Maybe it was Raccoon feces." So the drama will never allow full disclosure. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted May 24, 2012 Share Posted May 24, 2012 I'm a huge fan of DC, and I was thinking as I watched this that hyperventilation was one possible etiology for what appeared to be his carpal pedal spasming. One thing for certain, you had better be pretty good at first responder stuff as a boat captain on the Bering Sea as help is almost non-existent on a crab boat. Ding-ding-ding-ding! Give that man a prize! Having hung out my shingle in that arena I can say that "Stuff" happens out there. Remember this is entertainment after all. Some of the boat captains are pretty savy , others are.........not so good. There are some boats with medical sets that made me drool when compared to my "jump bag" up there.I spent more than a few hours in Cold Bay waiting for a CG HH-60 to deliver patients or riding a CG HH-65 to deliver a patient from the Bearing Sea for eval or MEDEVAC to Anchorage. You need to get out on the edge of the world to really have fun as a solo practioner. PS I'm still miffed that they cut my scenes from from the show a while back after saying I "could have been a contender"! Link to comment Share on other sites More sharing options...
burnpac Posted May 24, 2012 Share Posted May 24, 2012 Ding-ding-ding-ding! Give that man a prize! Having hung out my shingle in that arena I can say that "Stuff" happens out there. Remember this is entertainment after all.Some of the boat captains are pretty savy , others are.........not so good. There are some boats with medical sets that made me drool when compared to my "jump bag" up there.I spent more than a few hours in Cold Bay waiting for a CG HH-60 to deliver patients or riding a CG HH-65 to deliver a patient from the Bearing Sea for eval or MEDEVAC to Anchorage. You need to get out on the edge of the world to really have fun as a solo practioner. PS I'm still miffed that they cut my scenes from from the show a while back after saying I "could have been a contender"! Dude, I am in awe and not worthy to carry your jump bag. I fantasize about worlds like crab boats but would never have the mental / physical strength and stamina to do what they do. It is cool that you worked in their world. As an ex MIC Paramedic, my hat is off to anyone working at the ends of the earth battling death and disease. Link to comment Share on other sites More sharing options...
jmj11 Posted May 24, 2012 Author Share Posted May 24, 2012 Okay, you may be right. To a hammer . . . you know. I saw jerking and confusion. I've seen patients faking a tonic spasm (as they've witnessed with real seizures) during their psuedoseizures. But resp. alkalosis, as you say, could cause the carpal spasm. But regardless, a brown paper bag would have been curative in both circumstances . . . and much cheaper than a helicopter. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted May 25, 2012 Share Posted May 25, 2012 Okay, you may be right. To a hammer . . . you know. I saw jerking and confusion. I've seen patients faking a tonic spasm (as they've witnessed with real seizures) during their psuedoseizures. But resp. alkalosis, as you say, could cause the carpal spasm. But regardless, a brown paper bag would have been curative in both circumstances . . . and much cheaper than a helicopter. I said the same thing to my wife and non-PA coworkers when they asked what could the crew do. I've seen carpal-pedal spasm with HVS on more than one occassion. Link to comment Share on other sites More sharing options...
crieman Posted May 25, 2012 Share Posted May 25, 2012 My take on it was a spinal "stinger" or pinched nerve because he was working over his head when it happened suddenly, leading to hyperventilation and then carpal spasm. Can't wait to see the follow up. Love that show Link to comment Share on other sites More sharing options...
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