boeingb13 Posted September 9, 2008 Share Posted September 9, 2008 You show up on scene, 49 y/o white male, actively seizing on the couch, body is rigid salvating out of the mouth, pt has shit his pants, and is drenched in sweat. You take a manual B/P, cant get anything. You hook the leads up, he's showing a brady rhythm with a few pvc's. Pt has stopped seizing, states he feels terrible, he is not really having chest pain, alls he can see is " I feel like complete shit" Pt HX - No prior medical, no drugs, onset was 10 mins ago, nothing makes it feel better, ;ast food was eggs for breakfast, no allergies. Nothing out of the norm on anything. Pt drives 5 days a week delivering stuff to daytona, makes 1-2 trips a day. Pts left leg is slightly swollen. He keeps saying he cant breath, he is on 15 lpm via NRB, sats are 98%. Why did he sieze, what is the ultimate reason this guy is in this shape. Think out of the box on this, and look for the 2 main clues in what I typed. Once he got to the er they RSI'd him and instantly intubated him and took him for x-ray. Link to comment Share on other sites More sharing options...
WestSideBorderPatrol Posted September 9, 2008 Share Posted September 9, 2008 DVT? Link to comment Share on other sites More sharing options...
4kids Posted September 9, 2008 Share Posted September 9, 2008 Okay I might be grasping her boe, but he's a driver so alot sitting. I'm thinking possibly DVT, the clot moved and became a pulmonary embolism. Link to comment Share on other sites More sharing options...
boeingb13 Posted September 9, 2008 Author Share Posted September 9, 2008 I want to let a few more people take a shot, then i'll type the answer Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted September 9, 2008 Share Posted September 9, 2008 1-2 trips per day driving. could it be stimulants that he's withdrawing from? Trying to use them to keep awake driving. What about overdosing on red bull or one of those monster drinks - if he drinks 20 or so a day then he might have a little bit of an issue getting off them. or I can take the middle road and obvious choice that he has a DVT and it broke loose and went to the brain. Plus he shit his pants so I'm sure he felt like "shit' ha ha ha Or he's just a new onset seizure patient. Link to comment Share on other sites More sharing options...
SANDMEDIC Posted September 9, 2008 Share Posted September 9, 2008 I would say that his DVT broke loose and subsequently caused a pulmonary embolism which caused some interruptions or hyperstimulation of the Vagus nerve which resulted in the seizures. Key terms: sweating, difficulty breathing, and leg swelling, bradycardia. Link to comment Share on other sites More sharing options...
reaper Posted September 9, 2008 Share Posted September 9, 2008 What does he deliver? Could be a poisoning to something he hauls. Link to comment Share on other sites More sharing options...
SANDMEDIC Posted September 9, 2008 Share Posted September 9, 2008 What does he deliver? Could be a poisoning to something he hauls. Wow! yeah good thinking he does have the SLUDGE. Lots of decontamination to be done if that's what is going on. You never these days, people trying to save a buck by hauling stuff improperly. Link to comment Share on other sites More sharing options...
fireflymedic Posted September 9, 2008 Share Posted September 9, 2008 How long ago did he get home? I'm highly suspicious of a migrated DVT in this guy - is the calf warm? Also, there's the possibility of abcess and infection there which could cause the seizures, pvc's, etc - is he febrile by any chance? I admit though, I'm thinking pretty strongly that it's a DVT that migrated from the calf as most PE's are initially asymptomatic and many die within the first hour. I'd say he does feel like crap after seizing - I'm suprised he could talk to you at all though. Any difficulty breathing? Does he feel like he can't catch his breath? Can I have some vitals please? Sounds like a fun run - can I come and play? Link to comment Share on other sites More sharing options...
SANDMEDIC Posted September 11, 2008 Share Posted September 11, 2008 boeingb13 What is the scoop on this patient? We are all eagerly awaiting what the final outcome was. Link to comment Share on other sites More sharing options...
Recommended Posts