DartmouthDave Posted May 1, 2010 Share Posted May 1, 2010 Hello, You are an ALS crew (ACP/PCP) in a town of 70,000 people. ALS and BLS backup is available. Fire First Responders are available as well. It is winter and the weather and roads are quite bad. You have spent the morning on minor MVA's and collecting up the town drunks who are getting cold. You are dispatched to a new subdivision on the edge of town (30 minutes from the hospital due to evil weather.....you arrive in 10 minutes) for a pregnant women in 'active labour'. On arrival you and your partner are ushered into a large bedroom. There is a hint of panic in the air. The husband is very flustered. He states that this is his wife's third pregnancy. Everything has been going well until the last two weeks. His wife has been having a great deal of lower back and hip pain. Warm baths seem to help. When she got out of the tub her 'water' broke. The husband helped her to bed. He states that she was very weak. Once she got on the bed she had a seizure. Which has been going on for 10 minutes or more!! The wife is laying on the bed naked. Her eyes are closed. She quite tachypnea (rate 30's). Her skin appears pink and sweaty. He arms and legs a flexed abnormally. Her toes are curling outwards. Her fingers are fanning outwards and her arms appear rigid. The patient's mouth pursed in a tight circle and her eye lips are twitching. The patient's abdomen appears very pregnant. Their also is some staining on the bed sheets that look pinkish. The two other children are upstairs with the patient's mother. Cheers.... Link to comment Share on other sites More sharing options...
JackMaga Posted May 1, 2010 Share Posted May 1, 2010 Ok, let's start: get the husband and relatives out of the room; explain them you will get to them at soon as possible to ask them informations about the patient and to inform them of the situation; get the pt. on the floor in a position from where we can work as confortably as possible particularly at her head since we're probably going to be working on her airways; start primary evaluation: is she moving enough air? how's her pulse? Do we have vitals and what's does her rythm looks like on the monitor? Start O2, get a vein. As soon as possible I would like to talk to the husband: he said that the back pain had been going for two weeks: did they see their physician? Any history of hypertension, renal disease? Did they do blood/urine exams for the back pain? How about the previous pregancies, was there any problem? My first bet would be eclampsia but it could be a lot of other things... Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 2, 2010 Author Share Posted May 2, 2010 Ok, let's start: get the husband and relatives out of the room; explain them you will get to them at soon as possible to ask them informations about the patient and to inform them of the situation; get the pt. on the floor in a position from where we can work as confortably as possible particularly at her head since we're probably going to be working on her airways; start primary evaluation: is she moving enough air? how's her pulse? Do we have vitals and what's does her rythm looks like on the monitor? Start O2, get a vein. As soon as possible I would like to talk to the husband: he said that the back pain had been going for two weeks: did they see their physician? Any history of hypertension, renal disease? Did they do blood/urine exams for the back pain? How about the previous pregancies, was there any problem? My first bet would be eclampsia but it could be a lot of other things... Hello, The husband is moved out if the room and the anxiety level drops greatly. You do an assessment of the patient. She is able to open her eyes and looks at your. She has some trouble talking because her mouth is 'cramping'. She says her arms and legs feel 'numb' and 'cramped up'. VS are: BP: 150/90 HR: 110 NSR Resp: 34 Rapid and deep SpO2: 99% Temp: 37.5 A head-to-toe assessment findings: General Impression: A fit looking 29 year-old women who is obviously pregnant. An old hospital ID band in noted on her right arm. CNS: Her arms are still rigid and her fingers and toes are fanning outwards. Her mouth if fixed in an 'O' shape. She is lucid but says she can not get her arms and legs to, 'Do what she wants them to.' Her pupils are 5mm and reactive. She is quite anxious and is complaining of numbness in her arms and legs. Resp: Lungs clear as a bell. She is taking large deep breaths. CVS: Skin pink/warm/dry EKG shows Sinus Tachycradia ABD: Quite pregnant History: The husband is able to offer some history. This is her third pregnancy. The first two went to term and were delivered vaginally without complications. He thinks that his wife is at 38 weeks right now. For the last two weeks she has been seen at the hospital three times. The last time two days ago. Her chief complaint during these visits were lower back pain and left flank pain. No problems were found and the pain was due to the baby's position. She was given a script for Tyl#3 and Oxazepam 15MG QHS for trouble sleeping. Her last GP visit was last week. The husband isn't sure what was said. But, his wife said everything seemed fine. She has no medical history. Cheers.... Link to comment Share on other sites More sharing options...
CBEMT Posted May 2, 2010 Share Posted May 2, 2010 Sounds hella like a dystonic reaction.... Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 2, 2010 Author Share Posted May 2, 2010 Sounds hella like a dystonic reaction.... Hello, Excellent thought. The patient's appearance could fit a Dystonic Reaction. Her current medications are Tly #3 and Serax. No antipsychotic or antiemtic medication use. She is a clean living Lululemon Mom. She is lucid with stiff arms and fanning fingers and toes. Her mouth is puckered in an 'o' shape. She is breathing fast and deep. A very fit patient with a good set of lungs. The symptoms developed when her membranes ruptured and she became very anxious. This was compounded by the panicing (who thanks to JM) is in the room next door. Also, what other assessments could we do here as well? Cheers....... Link to comment Share on other sites More sharing options...
JackMaga Posted May 3, 2010 Share Posted May 3, 2010 Reading the original post I thought the woman was actively convulsing... I agree with CBEMT, it could very well be a distonic reaction, however the drugs she's taking don't cause such reactions... On the basis of the assesment and futher infos my workin diagnosis is hyperventilation crisis due to a stressfull situation; I would monitor her, try to reassure her and transport to ED. I would stay away from pharmacological sedation, particularly with benzos (who the hell prescribed her Oxazepam anyway?! ) and only try to calm her down talking to her. Also, what other assessments could we do here as well? I'm at loss here... 1 Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 3, 2010 Author Share Posted May 3, 2010 Reading the original post I thought the woman was actively convulsing... I agree with CBEMT, it could very well be a distonic reaction, however the drugs she's taking don't cause such reactions... On the basis of the assesment and futher infos my workin diagnosis is hyperventilation crisis due to a stressfull situation; I would monitor her, try to reassure her and transport to ED. I would stay away from pharmacological sedation, particularly with benzos (who the hell prescribed her Oxazepam anyway?! ) and only try to calm her down talking to her. I'm at loss here... Hello, 100% on the money ---> Hyperventilation Crisis Sorry about the first post. Sometimes it is hard to describe a complex presentation in words. Again, correct on the second point. No medication here that would cause a Dystonic Reaction. Further assessment.....I was think about an obstetrical assessment. Station. Position. Was an u/s done? Stuff like that. Cheers.... Link to comment Share on other sites More sharing options...
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