Consider the Alternative

     When you and your partner are dispatched to a law firm for a person down, dispatch advises a BLS engine company is also en route. On arrival, a receptionist directs you to the third floor, where the first responders have already obtained a first set of vital signs: BP 140/80, HR 130, RR 18. They have just started administering oxygen at 10 lpm via a non-rebreather and report a blood glucose of 130 mg/dL.

     An administrative assistant tells you the patient had been struck by an SUV while riding his bicycle the previous evening but refused EMS assistance on the scene. The patient told him this morning that he had an appointment with an alternative healer because he was unable to see his family physician. The man returned from lunch with a bottle of "homeopathic" medicine and his arm in a sling. About 15 minutes ago, he threw up and then passed out.

     Upon initial survey, you notice the patient's skin is hot, dry and flushed. His pupils are dilated and he seems confused and is hallucinating. Your cardiac monitor shows a sinus tachycardia at 140 bpm with no ectopy noted. As you continue a rapid trauma survey, you note a dressing on his right shoulder and the arm is secured in a sling and swathe. As the administrative assistant hands you the bottle of homeopathic medicine, the patient begins having a seizure.

     A comprehensive patient assessment is vital to providing the most appropriate and necessary treatments required for better patient outcomes. It becomes imperative to investigate all possible mechanisms or natures of the patient's condition and avoid tunnel vision when presented with what could appear as the obvious. The purpose of this case study is to provide insight into the use of alternative therapies and highlight potential adverse effects of nontraditional care.

     Alternative medical practices have become increasingly popular with the public, with nearly 50% of the U.S. population seeking some form of alternative care annually. Homeopathic and herbal remedies are more readily available and often cheaper than conventional medicines. This increased use of alternative medicine creates a unique challenge to EMS providers, necessitating a need to better understand their likenesses and differences, as well as the possibility that an ingredient in their makeup could be the cause of a patient's condition.

WHAT DO WE KNOW?
     Your patient was involved in a bicycle vs. SUV collision and is unable to tell what injuries he sustained due to an altered mental state that includes hallucinations and confusion. We know he has an arm/shoulder injury that has been splinted with a sling and swathe. Ventilations are within normal limits; however, his heart rate is rapid, blood pressure is elevated and skin color and condition are not consistent with possible traumatic injuries. His administrative assistant witnessed one emesis followed by what appeared to be a syncopal episode. There is a dressing on his right shoulder and his pupils are dilated. What do you suspect is going on: trauma, medication or both?

TRAUMA
     EMS providers are trained to recognize the many signs and symptoms related to trauma, some of which may develop many hours or days following the initial event. Do this patient's signs and symptoms indicate they stem from injuries the patient sustained from being stuck by an SUV?

     Traumatic brain injury (TBI), as well as internal bleeding, could be suspected as a result of this type of accident. Complete and comprehensive treatment requires that EMS investigate all possible causes of this patient's current condition.

     Based on Table 1 on page 82, can trauma be accurately ruled out as the cause of his current chief complaint?

MEDICATIONS
     What about that visit to the "alternative" medicine practitioner? What is that bottle of medication he brought back with him?