What would you think if you saw this patient?

  1. Just curious to know what other nurses think. To me it sounds obvious, but maybe I'm missing something...

    Let's say you have a patient in an outpatient clinic with the following symptoms: he cannot swallow, cannot talk, and is drooling because he cannot swallow properly. He never had problems with swallowing or talking before this. He is in his 20s, and has a history of cancer when he was a child. No facial drooping or other symptoms present. As a nurse, would you recommend:

    A)the patient should go to ER immediately for further evaluation, and it is most likely neurological rather than a GI issue

    Or

    B)the patient should be prescribed robinul and referred to a GI specialist.

    To me, A seems obvious. But in this case, the doctor went with B, and I still don't really understand why. Any insights?
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  2. 56 Comments

  3. by   Sour Lemon
    I would think ER for further evaluation just to be on the safe side ...but who takes a suddenly unable to speak or swallow patient to an outpatient clinic? That makes me think there may have been more detail discussed with the MD and that the changes were not as "sudden" as they were initially reported to be.
  4. by   quazar
    I do OB so this is totally out of my wheelhouse and I would probably be calling a code stroke. HOWEVER, since freaking out and calling in the calvary for backup is not a choice (I love you, rapid response/stroke team!!), then my choice is 1) send him to the ER.

    Now ask me something about uteruses because this question is freaking me out.
  5. by   macawake
    Quote from coffeemamaRN
    Just curious to know what other nurses think. To me it sounds obvious, but maybe I'm missing something...

    Let's say you have a patient in an outpatient clinic with the following symptoms: he cannot swallow, cannot talk, and is drooling because he cannot swallow properly. He never had problems with swallowing or talking before this.
    Personally, first off I'd like to rule out epiglottitis. (It could be caused by infection or injury to the throat).
  6. by   KelRN215
    These symptoms + history of cancer as a child would make me concerned for a late relapse in the CNS. What was the original cancer?
  7. by   Boomer MS, RN
    Quote from macawake
    Personally, first off I'd like to rule out epiglottitis. (It could be cause by infection or injury to the throat).
    Botulism?
  8. by   KelRN215
    *Also would like to add, late relapse of the original cancer OR secondary cancer from all the treatment he had as a child. I've seen a lot of secondary cancers YEARS after treatment for childhood cancer.
  9. by   oceanblue52
    I would also recommend the ER, not being able to swallow can lead to airway issues. Would be interesting to hear the doctors perspective.
  10. by   Boomer MS, RN
    Quote from macawake
    Personally, first off I'd like to rule out epiglottitis. (It could be caused by infection or injury to the throat).
    Definitely ER, not the least because of the reason given above. But maybe there is some information missing that would justify the MD's disposition. Very curious how it all played out. Hope the patient did OK.
  11. by   MunoRN
    What you're describing is angioedema with a threatened airway (inability to talk suggests swelling in the larynx) which is an automatic ED trip by medics in the event he requires intubation prior to ED arrival. I'm guessing (hoping) the MD had some reason to know there was no risk of the patient losing their airway.
  12. by   Purple_roses
    Considering the fact that my personal primary physician told me to go to the ER instead of his office for a sunburn, I would have to lean toward ER as the responsible choice. Anything that seriously compromises the airway or circulation warrants a trip to the ER...an anticholinergic might temporarily solve the problem (and is essentially a bandaid), but without knowing exactly what's causing these symptoms, who knows how long that bandaid is going to last.
  13. by   Orion81
    Quote from quazar
    I do OB so this is totally out of my wheelhouse and I would probably be calling a code stroke. HOWEVER, since freaking out and calling in the calvary for backup is not a choice (I love you, rapid response/stroke team!!), then my choice is 1) send him to the ER.

    Now ask me something about uteruses because this question is freaking me out.
    Lol, you asked for it....
    f you remove fibroids, will it create scar tissue that can prevent implantation? And if you have a somewhat small tumor, can it grow bigger over time?
  14. by   Orion81
    This is SO strange to me. Ok, the Robinul will decrease oral secretions, but how exactly is it going to suddenly make your ability to TALK and SWALLOW come back????? What the?

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