EMT Challenge Cases
CASE: HORSE TAILS
S: You receive an emergency call from John who is a 44 year-old male who complains of collapsing in the kitchen while just getting his breakfast. He collapsed to the floor and it took him nearly an hour to slide across the floor where he could reach a phone to call 911. He could barely move his legs and stated that "they feel like somebody poured gasoline on them and lit them on fire." He has had a recent history of backache and states that recently was unable to feel his genitals and he frequently became bladder and bowel incontinent. He had several back surgeries for sports related injures to his back. Other previous surgeries included knee surgery of right knee for torn medial meniscus from football injury and for an undescended testicle. Overall, patient is quite athletic for his age, working out daily in the gym. Wife and children were killed in a MVA two years prior to visit.
O: Patient was seen two months ago for same complaint by his PCP. Lortab 5 mg q 6h prn pain and Flexeril 10 mg bid was prescribed for back pain. Patient was advised to reduce the amount and intensity of exercise and seek physical therapy. Back pain seems to have worsened despite initial treatments. Testosterone levels were normal. It was felt that patient may be suffering depression and psychological issues relating to unresolved grief issues and was prescribed Prozac 20 mg bid and counseling. After a month, patient discontinued Prozac indicating that it made him have bizarre thoughts and behavior which worried his girlfriend. He sought treatment from a chiropractor for his back pain but still got no relief. Reflexes were completely absent from right leg and nearly absent from his left leg. Pulse and blood pressure were moderately elevated. The slightest attempt to move or handle patient results in his screaming and grapping anything around to help stop his movement.
How would you handle this patient?
