Cowgirl Seizure

[Timmy]

Just a continuation of my other rodeo thread.

Time In: 2350

You’re at the rodeo when a 23 year old female presents to the EMS tent complaining of feeling as though she is “going to have a seizure”.

- Patient has a history of epilepsy (tonic clonic) with the last seizure being back in 2003.

- Medications: Epilim BD 300mg AM 400mg PM Has been compliant today.

- Vitals BP:125/85 Pulse:102 Resp:18 Temp: Normal Pupils: are very dilated even with pen torch GCS: 15

- Patient feeling out of sorts stating it feels as though she is falling.

- Last meal was dinner time (1930) hamburger with one can of beer.

-Patient states about 5 hours before seeking assistance she went to the car after feeling tired and cant remember if she fell asleep or she ‘blacked out’ suddenly waking up about 3 hours later and taking a while to ‘find her bearings’

- After leaving the car the pt states he felt ok but has come to you some time later feeling funny.

- No history of recent trauma, NKA, nill drugs, primary/head to toe assessment NAD.

- It is quiet warm and patient has been hanging around the shoots for most of the day as her boyfriend is a cowboy.

- While the patient is on the stretcher she begins to shake her upper body and arms, almost like tremors, nothing to uncontrolled but noticeable, patient is now saying she has generalized muscle soreness all over her body.

- She is still talking to you in full sentences and is fully aware of her surroundings/

- Vitals do not change apart from pulse bumping to 110 but patients states she is feeling anxious.

- No recent visits to any form of medical professional in the last few months, last appointment with general practitioner was about 3 months ago for a review of medication and epilepsy.

- Patients stating she has never had any problems with her condition since 2003.

What's happening? Treatment plan?

[reaper]

She wanted to flirt with the medics? :wink:

[sirduke]

Focal Seizures?

[spenac]

blood glucose level?

[tniuqs]

Just a stab at this one, but Epileptics frequently develop tolerance to their rx, and time for a trip to the MD fer sure.

Ms Cowgirl, highly likely she already had a seizure from your history.

My guess is that she is describing an "aura" (sp) to you, a smell, a taste, or a visual illusion or color sometimes.

Dilated pupils = adrenergic response.

The last patient I had similar to this senario had a Grand Mal within 10 minutes, required ALS intervention asap, line, O2, Monitor, Pulse Ox, versed x 3 .... and narrowly missed chewing on plastic ETT, sux was pulled up but did not have to use it .... lucky for him.

cheers

[crazyemt5150]

I agree with tnuiqs, it sounds like she might of already had a seizure. Another thing if you take anti convulsion medications your not supposed to drink alcohol. That could be effecting her as well. Another thing that kind of strikes as weird, Is that she went to her car and was out for about three hours and doesn't remember a thing. Normally when someone has a seizure, they are postictal for a while but i don't think for that long. With the pupils being blown like that and you get no response with a pen light or what not, maybe there might of been a little drug use that the pt wasn't talking about or it could be an adrenal response. As for treatment pt requires als, at the time maybe some o2 via nasal canula, start a line tko, just incase the pt does have a seizure you can push meds. monitor and a d-stick for sure.

[firedoc5]

Just a stab at this one, but Epileptics frequently develop tolerance to their rx, and time for a trip to the MD fer sure.

Ms Cowgirl, highly likely she already had a seizure from your history.

My guess is that she is describing an "aura" (sp) to you, a smell, a taste, or a visual illusion or color sometimes.

Dilated pupils = adrenergic response.

The last patient I had similar to this senario had a Grand Mal within 10 minutes, required ALS intervention asap, line, O2, Monitor, Pulse Ox, versed x 3 .... and narrowly missed chewing on plastic ETT, sux was pulled up but did not have to use it .... lucky for him.

cheers

I concur. One of the guys I worked with had a son with epilepsy and even as a small child he would say something when he started to experience an aura. As he got older he would present almost identical to your cowgirl. But we did find out that some epileptics may experience aura but not recognize it until it's too late.

[iMac]

is THIS topic going postictal??

[Richard B the EMT]

Per friends at the Epilepsy Foundation, you really cannot trust an "Aura". Just as many who suffer seizure activity report the Aura after the episode as report it prior to it.

However, if, on an elevated train platform during a blizzard, someone with a history tells me they smell oranges, it's time for action.

[fireflymedic]

An aura is actually part of the seizure itself. It proves that it is partial onset and depending upon where it is originating depends on what type of aura they get or if they get one at all. Some people's seizures generalize so fast they don't realize or recognize the aura. From sounds of it, this was most definitely a seizure and post ictal time varies depending on individual. Some people bounce back in a few minutes from a partial seizure and others may feel out of it for up to 2 days with uncoordination and disorientation (resemble someone slightly buzzed) for generalized. In my book, she definitely wins a trip to the ER.