> *From:* Tim H-H <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Fri, 17 Nov 2006 21:30:40 +0000
>
> Just to clarify the point below;
>
>
>
> "What was the cause of his seizure?
>
>
>
> The most likely reason he vomited blood was he had a fit."
>
>
>
> It was determined on scene that the call came through as vomiting
> blood,
> because the person making the call had seen the blood from the bitten
> tongue
> and focused on that. Haematemesis was not found to be present. The
> witnesses
> of the fit said that there was a small amount of bright blood only.
>
>
>
> Tim H-H.
Bit of point missing going on here, Tim. My point was that he has an
unexplained tachycardia and a collapse to or from fitting. We do not
know the cause of the fit, and we must consider shock in the
differential diagnosis. The commonest cause for that is hypovolaemia in
this circumstance, and the commonest cause for concealed hypovolaemia is
GI bleeding. Although I did not make it explicit, I did not assume that
the GI bleed had led to haematemesis - indeed, if there had been real
haematemesis I would most certainly have expected the crew to transport.
As Helen has amplified, the issues revolve around the unexplained
persistent significant tachycardia in a (presumably fit) adult and the
expectation that a member of public should manage a patient with the
potential to become very ill quite rapidly.
R
/Rowley./
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