Kiwiology Posted June 11, 2009 Share Posted June 11, 2009 So I posted this earlier and it vanished .... You are called to a local frat house for a seizing female about 20. Her frat sisters report she was feeling unwell/N&V the last few days, uanble to pee and had been having cramps. Tonight she was partying when she began to complain of a headache and started to seize shortly thereafter. The college med school lab is at your disposal should you request it. Link to comment Share on other sites More sharing options...
Diazepam618 Posted June 11, 2009 Share Posted June 11, 2009 Okay so again, the scene is safe, is the patient in any acute distress ie; activley seizing, if not is she awake/alert, abc's vital signs are in order, if the patient can give a Hx get if not see what you can get from the frat house ho's, then basic ALS Iv, blood glucose, ekg, and O2 sat at the very least you have a line for transport just in case she starts to seize again. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 11, 2009 Author Share Posted June 11, 2009 Patient is still seizing; 5mg of midazolam settles it down nicely. You get the following from da ho's: S: N&V, lethargy, headache, unable to pass urine, generalised cramps x 2 days A: NKA M: NA P: NA L: Unknown E: Was hanging out with the other frat sisters BP is 160/100 PR is 84 reguar RR is 20 NL ECG shows inverted T waves in Lead II Link to comment Share on other sites More sharing options...
Diazepam618 Posted June 11, 2009 Share Posted June 11, 2009 Okay cool, cool, so with 5 mg of midazolam on board I would follow with benadryl of some other form of a anti-nausea specific med like zoran, have to say her vital signs seem stable, I would not be to worry with the ekg inturpetation at this point the only other thing I might do is put on a nasal cannula at 4lpm and transport, ofcourse I am about 5 minutes away from the er. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 11, 2009 Author Share Posted June 11, 2009 Cool potatoes .... with no prev sz hx any guess at what might have caused it? Link to comment Share on other sites More sharing options...
mobey Posted June 11, 2009 Share Posted June 11, 2009 I am not a taxi, nor am I 5min from ER. Is the pt Cx now? Temp? Pupils? NEuro exam? Track marks? BGL Unable to urinate?? Hmmm??? lemme think... Kidneys, ureter problems,,hmm I dunno better do the 2 quick meningitis tests. Don't give the answer yet, I got more assessment to come buddy! Link to comment Share on other sites More sharing options...
chbare Posted June 11, 2009 Share Posted June 11, 2009 Strange, I had a post disappear in one of my scenarios earlier today. I have a sneaky suspicion that I will hide as not to ruin what looks to be a great and relevant scenario. History of MDMA use? I suspect severe hyponatermia. Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 11, 2009 Author Share Posted June 11, 2009 Patient is unconscious w GCS 4 (1/1/2) Nuero will localize painful stimuli No track marks BGL is 6 mmol or 108ml/dl Temp is 37°C or 98°F Pupils dialated Negative meningitis New vitals PR 50 RR 24 BP 170/100 Link to comment Share on other sites More sharing options...
ERDoc Posted June 11, 2009 Share Posted June 11, 2009 Hmm, interesting BP and heart rate. Diazepam, don't be "one of those EMTs". Your EKG in an OD can be very important and very revealing. Where is the cramping? Is it abd cramping or muscular cramping? I'd like to order a cmp, tylenol, ASA, alcohol levels, serum osm, abg, urine drug screen, cpk, UA, urine preg to start. I'd also like to get more information from "da ho's" and I'll let our female members address that comment. FYI, they are sorority sisters, not fraternity sisters. Some food for thought on this case. She has been vomiting for several days and not making any urine. Could be dehydration, but do her vitals say dehydration? Link to comment Share on other sites More sharing options...
Arctickat Posted June 11, 2009 Share Posted June 11, 2009 (edited) Okay cool, cool, so with 5 mg of midazolam on board I would follow with benadryl or some other form of a anti-nausea specific med like zoran, Forgive my ignorance please. Is Benadryl a commonly used anti-emetic? I had no idea an anti-histimine would function as such. How much would you give in this case, taking into account the additive effects Benadryl has on alcohol and benzodiazapines? Edited June 11, 2009 by Arctickat Link to comment Share on other sites More sharing options...
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