A case of diaphoresis

K

Kenneth

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Wanted to see what the EMS community would do with the following patient.

37 yo male patient presenting with 7/10 headache with nausea. Patient was diaphoretic, pale, nauseous, lightheaded, dizzy. Pt responsive to verbal stimuli only, mumbles answers to questions. GCS 14. PMHx of family cardiac issues, Hx migraines. 12 lead shows sinus bradycardia @ 55 bpm. BP 120/88, RR 20, pulse ox 98%. negative abd pain.
 
BGL. IV. Pertinent questions. Sit and watch from my seat along the way.
 
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I check his sugar and hope really hard that that's the problem. Did this come on all of a sudden? Does this feel like his migraines usually do, or is it different? Did he take any drugs today? Eat anything questionable?

I re-check the pressure and check over the 12 lead again because none of it makes any sense... Then I drive quickly to a level 2+ trauma center if possible.
 
Any photosensitivity? What was the onset like - rapid, slow?

Like others said, get a BGL, perform the stare of life.


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BGL, 12-lead, get an IV and give him some Zofran. Do a stroke screen and if that is negative then a routine transport to the closest facility.

I’d also ask about recent travel, trauma, neck stiffness, photosensitivity, check for Kernig sign and Brudzinski sign pupil check, and vision check.

He is brady but not extremely. He is maintaining a good BP. As of right now I am not going to give atropine. His vitals aren't screaming Cushings triad. He also has a normal RR rate with a great SpO2 so I’m also not going to give any supplemental oxygen.

I had a similar patient several months ago with pretty much the same vitals and a Hx of migraines. Once the doctors were able to control his migraine his HR increased to a normal range. Doc said the bradycardia was more than likely due to the severe pain causing a vasovagal response
 
Standard ALS work up, the same twenty questions I ask every patient, and a ride to the hospital.

This patient may end up being sick, but he isn't any kind of sick I can fix, so he goes to the hospital.
 
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