I am going to tell a real life scenario that happened to my father and throughout the whole event, I was there to witness everything.
You are dispatched to a seizure call in at 9:30AM. You arrive to a patient who is a 60yo male who has a history of AKA left leg, diabetes,ESRD, hypertension and hyperlipidima. Family states he complained of a 8/10 headache for the last hour of dialysis the night before, still had the headache after 1000mg of Tylenol but fell asleep around 12am. They tried to wake the patient up at around 9AM, and although he was moving his hands and feet slightly, he was not able to speak or open his eyes. Patient subsequently had a seizure(with no history of any seizure prior) for 30 seconds and was foaming at the mouth, which prompted 911 response.
You arrive and find the patient laying down breathing but unresponsive. Vitals: BP is 217/110, RR is 14, BGL is 200 and SP02 is 99%. EKG looks normal, states RBBB but family says he has had that for years.
Current medications are: Atorvistatin 40mg, Lantus 35units, Humalog sliding scale, Gabapentin 100mg, Aspirin 81mg and Metropolol 50mg ER.
You transport the patient to the closest hospital 5 blocks away, which happens to be the hospital where the AKA was done, so all medical history is easily available. During the short trip, you suction and establish an IV to the right arm.
Hospital Treatment: Stat CT which proves normal(no midline shift, no actue or past stroke). Labs are normal except Potassium is 7.4(normal is 3.5-5.5). Blood pressure medication given and patient transported to Step-Down Unit as no ICU beds are available. Dialysis is emergently done upon arrival to the Step-Down Unit because of the critical Potassium value.
Here is what is interesting: My father(the patient) did not wake up for 2 days, even though he was on no sedation whatsoever. His blood pressure was well controlled after the initial 217/110, he would move his hands and feet a little and even scratch his nose, but he could not hear us or open his eyes. Magically, on the 3rd day he woke up a little confused. Over the next 4 days, he got 100% better and was at his baseline by the 7th day, with no brain damage or evidence of a stroke/TIA after an MRI scan. He was discharged after day 7 with better blood pressure medications and anti-seizure medications to continue until a follow up visit with a neurologist that can clear him to stop it. After 1 week, the neurologist cleared him to stop Dilantin.
Can anyone guess the diagnosis? It's pretty uncommon.
Ask me any follow up questions if it will help you. I have access to all the lab results, imaging results and consultation notes.
You are dispatched to a seizure call in at 9:30AM. You arrive to a patient who is a 60yo male who has a history of AKA left leg, diabetes,ESRD, hypertension and hyperlipidima. Family states he complained of a 8/10 headache for the last hour of dialysis the night before, still had the headache after 1000mg of Tylenol but fell asleep around 12am. They tried to wake the patient up at around 9AM, and although he was moving his hands and feet slightly, he was not able to speak or open his eyes. Patient subsequently had a seizure(with no history of any seizure prior) for 30 seconds and was foaming at the mouth, which prompted 911 response.
You arrive and find the patient laying down breathing but unresponsive. Vitals: BP is 217/110, RR is 14, BGL is 200 and SP02 is 99%. EKG looks normal, states RBBB but family says he has had that for years.
Current medications are: Atorvistatin 40mg, Lantus 35units, Humalog sliding scale, Gabapentin 100mg, Aspirin 81mg and Metropolol 50mg ER.
You transport the patient to the closest hospital 5 blocks away, which happens to be the hospital where the AKA was done, so all medical history is easily available. During the short trip, you suction and establish an IV to the right arm.
Hospital Treatment: Stat CT which proves normal(no midline shift, no actue or past stroke). Labs are normal except Potassium is 7.4(normal is 3.5-5.5). Blood pressure medication given and patient transported to Step-Down Unit as no ICU beds are available. Dialysis is emergently done upon arrival to the Step-Down Unit because of the critical Potassium value.
Here is what is interesting: My father(the patient) did not wake up for 2 days, even though he was on no sedation whatsoever. His blood pressure was well controlled after the initial 217/110, he would move his hands and feet a little and even scratch his nose, but he could not hear us or open his eyes. Magically, on the 3rd day he woke up a little confused. Over the next 4 days, he got 100% better and was at his baseline by the 7th day, with no brain damage or evidence of a stroke/TIA after an MRI scan. He was discharged after day 7 with better blood pressure medications and anti-seizure medications to continue until a follow up visit with a neurologist that can clear him to stop it. After 1 week, the neurologist cleared him to stop Dilantin.
Can anyone guess the diagnosis? It's pretty uncommon.
Ask me any follow up questions if it will help you. I have access to all the lab results, imaging results and consultation notes.
