Acute Onset Diarrhea, emesis and malaise – paramedic student IV insertion


• Scene – 12 lead. IV, VS, CBG
• En route – TT, VS
• Hospital – unk


• Pt responded with lower BP en route with TLC and calm demeanor.
• No meds were given en route.


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Diarrhea
• Malaise
• Emesis
• Hypertension

Differential Diagnosis

• Electrolyte abnormality (hypokalemia)
• Dehydration
• Hypertensive crisis
• Myocardial infarction
• Hyperthyroidism
• Peptic ulcer disease

Patient Workup History

• Patient states – she has had diarrhea for 3 days with some relief from immodium AD. She has vomited twice over the same 3 days.
• States that her cognitive perception is not normal when this happens.
• She has had low potassium in the past.
• She gets a fever only at night of @ 100 F
• Today is the last day for her clonidine.

Physical Exam

• BP – on scene 216/95, en route 137/74
• GCS -15
• EKG – NSR on 4 lead and 12 lead
• CBG – 147

Editor’s Notes

The patient presents with non specific symptoms. The patient’s significant hypertension should be noted and compared to known baseline. The patient’s mental status seems intact. There is a student video of an IV insertion and a supplemental file.

-Dr. David Spiro

Suggested References



• Gender: Female • Age: 64 year • Height: Not Available • Weight: Not Available


• Temperature: 98.3 F/36.8 C • Blood Pressure: 216/95 • Heart Rate: 68 • Respiratory Rate: 16 • Pulse Oximetry: 99% RA

Signs and Symptoms

3d diarrhea, vomiting, low-grade fever.

History Medical

• PMH: HTN, factor 5 • Allergies: codeine,vicodin • Dispatch info: weakness and diarrhea


• Lives alone in an apartment, has friends checking on her daily.


• Ranitidine, nitro stat, simvastatin, thyroid meds, coumadin, clonidine

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