TheLocalMedic
Grumpy Badger
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Good one from this past month:
30's female found actively seizing in a really crappy "home" (read: tweaker pad) that has virtually no furniture in it. Patient's "husband" says that she has been seizing for "about an hour", seizures off and on and "not making sense" between seizures (read: postictal, duh!) This guy was so clueless that he had even written the alphabet down on a sheet of paper and was trying to have her point to letters to spell out what was wrong with her (like she was going to spell out S-E-I-Z-U-R-E ?)
So, whatever... guy apparently doesn't realize that multiple (5+) seizures isn't normal and doesn't call 911 until an hour after she starts going off... He states no history, no meds and no allergies.
2 mg versed later the seizure is done and we're hauling her out to the ambulance. And here's where it gets interesting...
HR 140-150, resp 40+ with loud phonation, temp of 103 F, blood glucose of 79, pupils extremely dilated and initial BP of roughly 130/60. I suction her out and remove a significant amount of clear sputum from the oropharynx. And then we transport.
She remains GCS 3, still tachy at 140+, tachypneic 40-60 with phonation and her BP starts crashing. 130/60 becomes 90/40 becomes 60/30 and then isn't able to get a good reading. I dump fluids, pop in a second line, pressurize both saline bags and still can't get a pressure (weak carotid but not much else).
We arrive at the ED and they jump on her, but due to the system being super busy I'm not able to hang out to find out what's wrong with her. My initial tentative diagnoses were either a meth OD (although the "husband" adamantly denied any drug use) or sepsis.
I found out what exactly was going on with her later, but I'm curious as to what your thoughts are as to what might have been going on with her.
30's female found actively seizing in a really crappy "home" (read: tweaker pad) that has virtually no furniture in it. Patient's "husband" says that she has been seizing for "about an hour", seizures off and on and "not making sense" between seizures (read: postictal, duh!) This guy was so clueless that he had even written the alphabet down on a sheet of paper and was trying to have her point to letters to spell out what was wrong with her (like she was going to spell out S-E-I-Z-U-R-E ?)
So, whatever... guy apparently doesn't realize that multiple (5+) seizures isn't normal and doesn't call 911 until an hour after she starts going off... He states no history, no meds and no allergies.
2 mg versed later the seizure is done and we're hauling her out to the ambulance. And here's where it gets interesting...
HR 140-150, resp 40+ with loud phonation, temp of 103 F, blood glucose of 79, pupils extremely dilated and initial BP of roughly 130/60. I suction her out and remove a significant amount of clear sputum from the oropharynx. And then we transport.
She remains GCS 3, still tachy at 140+, tachypneic 40-60 with phonation and her BP starts crashing. 130/60 becomes 90/40 becomes 60/30 and then isn't able to get a good reading. I dump fluids, pop in a second line, pressurize both saline bags and still can't get a pressure (weak carotid but not much else).
We arrive at the ED and they jump on her, but due to the system being super busy I'm not able to hang out to find out what's wrong with her. My initial tentative diagnoses were either a meth OD (although the "husband" adamantly denied any drug use) or sepsis.
I found out what exactly was going on with her later, but I'm curious as to what your thoughts are as to what might have been going on with her.
h34r: