BushyFromOz Posted July 19, 2011 Author Share Posted July 19, 2011 Bump any thing to add, ill whack the answer up tomorrow if not Link to comment Share on other sites More sharing options...
DFIB Posted August 4, 2011 Share Posted August 4, 2011 I would be inclined to lean toward intracraneal pressure (blown L pupil) The rapid onset makes me think of a bleed. Although the proggressively worsening behavior could indicate a tumor, cisticercosis or some other rapid growing intracraneal mass. Link to comment Share on other sites More sharing options...
BushyFromOz Posted August 4, 2011 Author Share Posted August 4, 2011 When i followed up on this pt the attending ER Doc (funny bloke, ukraine accent i think) says this. "I a dunno what wrong with him, i look at da blood, it fine, i look at da heart, it fine, i look at a da CT, it fine. I RSI him, send him upstairs, they figure him out" This pt has rapid onset dementia, probably been masked for a couple of months by his depression, the mood swings etc were probably more confusion then lack of social engagement. Its unkown why suddenly developed a GCS of 8 or the blown pupil. he was extubated 2 days after admission and still had a GCS of 8, dementia being diagnosed a week or so afterwards (im not sure how it was arrived at - exclusion i guess) The blown pupil remains a mystery, but he still has it. Link to comment Share on other sites More sharing options...
Siffaliss Posted August 4, 2011 Share Posted August 4, 2011 So the initial 12 lead showed NSR, what about serial 12 leads or any evidence of prolonged QT in serial 12's? Chance he got into someone else's meds, perhaps TCA's? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted August 5, 2011 Share Posted August 5, 2011 Ok a few things I noticed... Temp down 1.3 C what is the weather outside? Also the GCS has droped from 6 to 5. I can't tube but ALS would be on this one (less then 8 intubate LOL) Bushy what was the time between the inital assesment and these current findings? Just so I can figure out how fast he is decompinsating. Being he has NSR I am not thinking cardiac. 130/90 w/ a hx of hypertension isn't too concerning at this point. You say he ate for lunch, when was that from this time? Did he take his insulin properly or is he on a pump? The hx of depression is a flag for me especially with the eyes, could he have overdosed? did he have an interaction with any other meds? Being she stated his syptoms have gotten worse recently and the only new hx would be the infection are we looking at interaction vs overdose? I will wait for some of those answers. It is completely ridiculous that you are a BLS provider...change that, would you? Dwayne Link to comment Share on other sites More sharing options...
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