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Part 1 of 2 Progressive scenario

34 posts in this topic

Posted · Report post

Hey all, this is going to be a fairly long scenario as we follow this patient so I will break it up into 2 scenario's, I do think there are going to be many learning points for our new (and old) members.

This will be 100% accurate to what I was presented with.

You are called to a home in a remote town of 2000 people for a female post seizure. Non-priority call.

You have an acute care clinic in this town which is "closed to ambulances" due to a nursing shortage, but you know the Doc (Family medicine) that is on tonight and feel comfortable taking a patient there if you need a hand stabilizing. The Doc will not assume care of a patient though nor admit anyone.

Closest "Open" ER is 30min away. No surgical unit, no specialties. Just family practice Doc's doing thier best.

City hospital is 2.5hrs away

The home you go to is well kept, with lots of harmless animals. There is a thick smell of cigarette smoke in the air.

You are greeted at the door by a hysterical 300lb man yelling at you "My wife needs help"

You arrive to the livingroom to find a 62y/o F with her head in a bucket vomiting food.

Husband states she is an epileptic & takes dilantin. She has not had a seizure in 12 years, but just had one prior to him calling 911.

She was diagnosed epileptic 12 years ago - post hemmoragic stroke that left her with no deficits (except the epilepy).

This seizure today lasted approx 2 min.

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Posted · Report post

Is she still actively seizing? if not>

How long did the seizure last?

Does she have any after effects from the seizure activity?

What was she doing prior to the seizure beginning?

Any recent illness?

Any meds besides dilantin?

Whens the last time serum levels were checked?

Any other current medical HX?

Vitals?

BP high or normal

Pupils?

Blood glucose?

ETOH?

recreational pharmaceuticals?

12 lead shows?

Once we get these answers, then a phone call to your friend, the Doc in the box might be in order to determine if you really need to take a 2 1/2 hr ride to the city hospital with a neuro dept.

OK : I'll let someone else play now :turned:

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Posted · Report post

Is she still actively seizing? if not>

How long did the seizure last? Approx 2min

Does she have any after effects from the seizure activity? Like the vomiting? Not sure what you're asking

What was she doing prior to the seizure beginning? Smoking, watching TV

Any recent illness? No

Any meds besides dilantin? Amlodipine, Metoprolol, Celebrex, Atorvastatin, Lansoprazole, Ropinirole

Whens the last time serum levels were checked? She can't remember

Any other current medical HX? Nope

Vitals? 142/90 RR20. P102 Sat 94% BGL10.4mmol Temp 36.7

BP high or normal Yes

Pupils? ERL

Blood glucose?

ETOH? No

recreational pharmaceuticals? No

Once we get these answers, then a phone call to your friend, the Doc in the box might be in order to determine if you really need to take a 2 1/2 hr ride to the city hospital with a neuro dept.

OK : I'll let someone else play now :turned:

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Posted (edited) · Report post

Ok I have a few questions, that sugar seems a bit high post seizure, as well as a relatively high heart rate for a pt. on a beta blocker.

12 lead?

Could you describe the seizure activity for me?

What's her mentation now and what's her baseline post stroke. How is her medication compliance? And is she having parkinsonian symptoms or restless leg at baseline?

BAYAMedic

And what was on TV at time of seizure?

Edited by BAYAMedic

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Posted · Report post

What has she ingested or been exposed to in the last 24 hours? Is she the smoker? (I am assuming she is based on her O2 sat)

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Posted · Report post

Does she have any after effects from the seizure activity? Like the vomiting? Not sure what you're asking

Mobey: I was looking for any new stroke type deficits or other physical findings of loss of function , post seizure

Pupils, nystygmus petichia

again: 12 lead shows?

Amlodipine, Metoprolol, Celebrex, Atorvastatin, Lansoprazole, Ropinirole: With these meds , she obviously has other concurrent medical problems.

Bi lateral pulses & BP's

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Posted · Report post

What does she look like in general,

skin,

level of consciousness,

12 years ago, how often would she have seizures, would she get them back to back,

does she look well kept,

Any recent injuries, falls, bumps on the head,

Any change in her daily routine,

Was the seizure sudden or did she know it was coming (aura)

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Posted · Report post

Any recent trauma/ possible head injury? Was she feeling sick/ nauseous before the seizure, or is that new onset? What's her mental status?

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Posted (edited) · Report post

No trauma other than patient complains of pain in her right elbow

Seizure was typical grand maul description

No neuro symptoms

No recent falls etc.

Yes a smoker, 1/2 pack/day x25+ yrs.

General appearance is unwell. Coulor is greyish, vomiting, slight diaphoresis.

ecg.jpg

Sorry for the small pic.... not sure how to expand it.

Ctrl + should help.

Edited by mobey

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Posted · Report post

Sorry Mobey: It's so dark and small as to be unviewable. Yep it's an ECG from a lifepack , other than that ????????

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