Call to an epileptic. On our arrival patient is in his bed, still in a seizure, but also his breath reveals that he has massive pulmonary edema - we can hear crackles from the apartment entrance.
10mg of diazepam iv. breaks the seizure and we can start to examine the guy:
He's cyanotic, skin clammy but warm. His bowels let go.
GCS 3, eyes turned to the left all the time. Pupils normal, equal, with lazy reaction to light.
He somehow maintains his airway open, 30 labored breaths per minute, massive crackles, he's literally drowning in the fluid in his lungs. No traces of vomit anywhere. SpO2 69%.
BP 210/120; HR150/min. EKG: sinus tachycardia with no signs of ischemia in 3 lead.
BGL 216mg/dl
He lives with a mentally slow nephew who claims that the patient has been in a condition like this for about an hour (before that "he was better" - whatever that means). He had a stroke couple of months back (can't tell what kind) and points to us patient's medicines which are some non prescription pills for improving circulation in the brain. We can't get any more useful information from the nephew.
Apparently patient is in at least 2 serious conditions here and taking care of one could potentially worsen the other. Wonder what would be your priorities in this case and what treatment.
10mg of diazepam iv. breaks the seizure and we can start to examine the guy:
He's cyanotic, skin clammy but warm. His bowels let go.
GCS 3, eyes turned to the left all the time. Pupils normal, equal, with lazy reaction to light.
He somehow maintains his airway open, 30 labored breaths per minute, massive crackles, he's literally drowning in the fluid in his lungs. No traces of vomit anywhere. SpO2 69%.
BP 210/120; HR150/min. EKG: sinus tachycardia with no signs of ischemia in 3 lead.
BGL 216mg/dl
He lives with a mentally slow nephew who claims that the patient has been in a condition like this for about an hour (before that "he was better" - whatever that means). He had a stroke couple of months back (can't tell what kind) and points to us patient's medicines which are some non prescription pills for improving circulation in the brain. We can't get any more useful information from the nephew.
Apparently patient is in at least 2 serious conditions here and taking care of one could potentially worsen the other. Wonder what would be your priorities in this case and what treatment.
