What's wrong with this patient?

[ffemt8978]

Paged to a 42yoM C/C Fell from a standing position. Upon arrival, family advise us pt. had a seizure and then fell. Pt. disorientated to date, place and events and did not recognize his own family members. Pt. having severe Lt. shoulder pain from where he struck a sprinkler head, but not other injuries noted.

Pupils were PERL but a bit sluggish, and lungs clear & equal bilat. We put the patient on the monitor, and he throws a PVC and then had elongated T-waves with a double hump in them. The T-waves appeared to be inconsistently spaced from the QRS complex. Pt. denies any C/P.

Pt. has no significant hx, including cardiac, neuro, and seizures. This was the patient's first seizure.

Any ideas what could be wrong with this guy?

 

[Chimpie]

I don't know, but you may want to get him to a hospital. :lol:

 

[rescuecpt]

Originally posted by Chimpie@Jul 7 2005, 07:18 AM
I don't know, but you may want to get him to a hospital. :lol:

 

[Flight-LP]

I am assuming from your description that the patient was outside (unless he has an indoor sprinkler system :lol: ). What was the temperature and humidity? If it is anything like the current heat wave here in Texas, it is possible that the pt. could be quite febrile, thus causing the seizure, and may be experiencing extreme electrolyte imbalances. Outside of cardiac ischemia or infarct, the most common reason for T wave prolongation or variences in amplitude is due to shifting of electrolytes, namely potassium. Also, the ingestion of cold drinks (i.e. perfect on a hot day)can cause T wave changes due to the esophogus' close proximity to the left ventricular wall, thus possibly delaying ventricular repolarization. Thats my thoughts anyways, regardless treat what you see, c-spine him, O2, IV titrate to BP or level of visible dehydration, check temp and treat hyperthermia as needed transport to ER, treat any further seizure activity seen.............................

 

[TTLWHKR]

What's wrong with this patient?

They need an ambulance?

 

[ffemt8978]

Originally posted by Flight-LP@Jul 12 2005, 05:48 PM
I am assuming from your description that the patient was outside (unless he has an indoor sprinkler system :lol: ). What was the temperature and humidity? If it is anything like the current heat wave here in Texas, it is possible that the pt. could be quite febrile, thus causing the seizure, and may be experiencing extreme electrolyte imbalances. Outside of cardiac ischemia or infarct, the most common reason for T wave prolongation or variences in amplitude is due to shifting of electrolytes, namely potassium. Also, the ingestion of cold drinks (i.e. perfect on a hot day)can cause T wave changes due to the esophogus' close proximity to the left ventricular wall, thus possibly delaying ventricular repolarization. Thats my thoughts anyways, regardless treat what you see, c-spine him, O2, IV titrate to BP or level of visible dehydration, check temp and treat hyperthermia as needed transport to ER, treat any further seizure activity seen.............................

Temp was mid-70's without excessive humidity. His temp was a little high, but nothing to be overly concerned with (I don't remember exactly what it was, but it was with .0.5F of normal.)

Our treatment consisted of 15lpm, IV NS TKO, 3-lead ECG, and high flow diesel to an ALS intercept. Our protocols specifically prevent us from using MOI as a criteria for C-spine control and the pt. was not c/o neck/back pain.

I was wondering about the dehydration aspect, but the pt was a remarkably easy stick for the IV (unlike any other dehydration pt. I've had).

 

[TTLWHKR]

Board em for the hell of it... I used to do it just so we could go back to CC to restock.. and get cookies, etc., from the office that the Platoon Chief's wife made like every day. City protocol was that we boarded anyone that fell from standing height or higher, and we ran the bus with no less than 3 spine boards w/ proper CIDs. In our case we used disposable "Head On" blocks, medical duct tape and no CID pads like you find with the block and velcro ones like ferno makes.

 

[ffemt8978]

I don't always agree with our protocols, especially the part about not using MOI to determine if a pt. needs boarded and collared, but I would have been hard pressed to justify it in this case. There was absolutely no sign of head trauma, not even a scratch.

Anything more than a standing height, and I would probably board them and use my "Creative Report Writing 101" skills to justify it.

 

[shorthairedpunk]

are you telling me that you can be reprimanded for immobilizing a patient and would have to be "creative" in a report to justify it?

Im all against basing immobilization on MOI alone, but I also am all about not being limited by strangling protocols.

 

[medic03]

Originally posted by ffemt8978@Jul 7 2005, 12:21 AM
....We put the patient on the monitor, and he throws a PVC and then had elongated T-waves with a double hump in them.....

could it have been a U wave after the T, u sure it was a double hump? Well overall it sound interesting, but I'm going to agree with flight-LP and go with electrolyte imbalances. so did u find out what was wrong with him?

 

[ffemt8978]

Originally posted by medic03+Jul 12 2005, 10:51 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (medic03 @ Jul 12 2005, 10:51 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978@Jul 7 2005, 12:21 AM
....We put the patient on the monitor, and he throws a PVC and then had elongated T-waves with a double hump in them.....

could it have been a U wave after the T, u sure it was a double hump? Well overall it sound interesting, but I'm going to agree with flight-LP and go with electrolyte imbalances. so did u find out what was wrong with him? [/b][/quote]
Never did find out what was wrong with him.

The double hump in the T-wave can best be described as the "normal" T-wave with a second wave added on to it at the end. It kind of looked like a profile of a two steps and was about twice as elongated as a normal T-wave.

shorthairedpunk Posted on Jul 12 2005, 10:14 PM
are you telling me that you can be reprimanded for immobilizing a patient and would have to be "creative" in a report to justify it?

Im all against basing immobilization on MOI alone, but I also am all about not being limited by strangling protocols.

Yes, I can. I agree with you about MOI immobilization, but I would at least like to have the option to immobilize based on MOI if I feel it's necessary.

 

[rescuecpt]

Originally posted by medic03+Jul 13 2005, 12:51 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (medic03 @ Jul 13 2005, 12:51 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ffemt8978@Jul 7 2005, 12:21 AM
....We put the patient on the monitor, and he throws a PVC and then had elongated T-waves with a double hump in them.....

could it have been a U wave after the T, u sure it was a double hump? Well overall it sound interesting, but I'm going to agree with flight-LP and go with electrolyte imbalances. so did u find out what was wrong with him? [/b][/quote]
I have a u wave. Sometimes. It's weird. And mysterious.