Arctickat Posted September 16, 2013 Author Share Posted September 16, 2013 Whats the EKG showing How long does the seizure last Less than 2 min Do we have a Istat to check lactate as PM requested No, Unfortunately what is the BGL in mg/dl Do the math yourself Did the EKG change after the seizure No change Would versed be a choice to control the seizures 5mg Versed administered, You've arrived at the hospital. Any thoughts to the underlying cause before I post the labwork? BP 127/83 HR 136 RR 14 spontaneous resps SpO298% on 100% O2 through the ventilator etCO2 36mm/hg Summary: Cardiac History AMI x 4 Diabetic History (Non Insulin Dependent) Prosthetic Eye Current untreated significant Infection Post Cardiac arrest ROSC after 15 min CPR and 1 defib 1mg Epi for Bradycardia PEA Intubated ECG Sinus Tach 5 mg Versed for Seizure Bilat IVs running TVO Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted September 16, 2013 Share Posted September 16, 2013 (edited) Hyperglycemia - secondary to septic based on the wound on the leg. I know my sugar always gets out of whack when i have an infection. His glucose was very high 449 (thanks Scubanurse) and the fact that he had that wound on his leg that I believe appeared infected, I'm going with quite an infection. I don't think he had an MI. Edited September 16, 2013 by Captain ToHellWithItAll Link to comment Share on other sites More sharing options...
scubanurse Posted September 16, 2013 Share Posted September 16, 2013 I'd like to see an ABG? Link to comment Share on other sites More sharing options...
Arctickat Posted September 16, 2013 Author Share Posted September 16, 2013 I'd like to see an ABG? Not available at my facility. Link to comment Share on other sites More sharing options...
DartmouthDave Posted September 16, 2013 Share Posted September 16, 2013 (edited) Hello, Sepsis is a concern here. So, let’s get some cultures and then start the antibiotic therapy as soon as possible. A urine tox could be a good idea as well. The seizures are worrisome. There could be a CNS infection. Or, is he on any medications that could lower a seizure threshold? (Haldol, Cipro, ect…) Or, any medications that can cause seizures? (Demerol) Also, I agree that an Amiodarone isn't a good idea here. The AF is due to a critical illness and in these case, from what I have seen, Amiodarone isn't very helpful. Hypothermia. Consult with the critical care service of the hospital this fellow is going to. If the code is due to sepsis then hypothermia may bad idea due to the suppression of the immune system. Especially if it is in his CNS. Lastly, from my point of view, in most cases a little sedation is a good idea. Sure, you may have a depressed GCS but this doesn’t mean the negative effects various interventions shouldn't be blunted. But, in this case, I might have missed the seizure. Cheers Edited September 16, 2013 by DartmouthDave Link to comment Share on other sites More sharing options...
Arctickat Posted September 17, 2013 Author Share Posted September 17, 2013 Not sure where you're seeing AF Dave, however, I'll throw the last of the info that I am able to provide at this time. These are all we have available for labs, but were sufficient to make the diagnosis. We can't do Tox or ABGs. The PDF files of the lab reports can be downloaded from the downloads section here: http://www.emtcity.com/files/download/28-scenario/ Link to comment Share on other sites More sharing options...
DartmouthDave Posted September 17, 2013 Share Posted September 17, 2013 Hello, Opps. I was mistaken on the AF. Looking at the UA and the elevated GBL DKA seems reasonable. The infection could have caused the DKA as well. Sepsis is a safe bet with the foot and the elevated WBC (32). The is a touch of renal failure as well. As for the seizure, I am not sure. Cheers Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted September 17, 2013 Share Posted September 17, 2013 febrile seizure? Or just caused by infection hitting his brain? Link to comment Share on other sites More sharing options...
scubanurse Posted September 17, 2013 Share Posted September 17, 2013 I was going to say DKA, Sepsis r/t possibly osteomyelitis with the hx of DM. Link to comment Share on other sites More sharing options...
triemal04 Posted September 17, 2013 Share Posted September 17, 2013 Nasty. Probaby sepsis and DKA. Whether or not this is what precipitated the arrest or there was a primary cardiac cause is still debatable. If the infection has reached the heart and is causing something like myocarditis that would help explain it. However... 1L bolus of fluid on top of the 500ml No antiarrhythmics. 5mg of versed for seizure control (and sedation after the fact) would seem appropriate. With the rate dropping on it's own no need for rate control. A chem7 or chem12, cbc, cardiac panel and lactate are needed (and partially done). If you carry them it would be good to start antibiotics (cipro would probably be ok) and if possible (doubt it) draw cultures first. No cooling. Continue with the previous treatements and settings. Sick dude. Link to comment Share on other sites More sharing options...
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