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What would you think if you saw this patient?

Nurses   (13,096 Views 57 Comments)
by coffeemamaRN coffeemamaRN (New Member) New Member

1,288 Visitors; 11 Posts

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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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Sour Lemon has 9 years experience.

681 Likes; 2 Followers; 28,826 Visitors; 4,064 Posts

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.

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quazar has 20 years experience.

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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. ;)

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macawake has 10 years experience.

2 Likes; 72,083 Visitors; 1,101 Posts

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).

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KelRN215 has 10 years experience and works as a Complex Care Manager.

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These symptoms + history of cancer as a child would make me concerned for a late relapse in the CNS. What was the original cancer?

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Boomer MS, RN has 17 years experience.

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Personally, first off I'd like to rule out epiglottitis. (It could be cause by infection or injury to the throat).

Botulism?

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KelRN215 has 10 years experience and works as a Complex Care Manager.

38 Likes; 67,249 Visitors; 7,344 Posts

*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.

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5,217 Visitors; 462 Posts

I would also recommend the ER, not being able to swallow can lead to airway issues. Would be interesting to hear the doctors perspective.

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Boomer MS, RN has 17 years experience.

1 Like; 4,402 Visitors; 501 Posts

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.

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MunoRN has 10 years experience and works as a Critical Care.

32 Likes; 63,181 Visitors; 5,926 Posts

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.

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20,243 Visitors; 1,763 Posts

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.

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Orion81RN has 5 years experience.

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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?

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