benanzo Posted February 15, 2006 Share Posted February 15, 2006 You are called to a busy shopping mall to see a 35 y/o male unk medical. You arrive to find a man sitting on some stairs with two men sitting by him. He went to lunch 1 h 30 m ago. They say they called because when he didn't come back from his lunch break 30 min ago they came downstairs to find him. They found him sitting in his current position but wouldn't anwer any questions and had a distraught look on his face. His body was very rigid and was not appearing to comprehend any of their questions. You find him sitting upright alert but non-verbal. He gives no indication that he's comprehending anything around him. HEENT= PERRL, wont track, no droop, no signs of trauma neck/back=no jvd, no td chest=no dyspnea, clr = bilat, =rise and fall abd=soft, non distended, no masses VS= BP 154/80, RR 22, NSR @80, BS 110, O2S 98%RA NO PMH, NO Meds, NO Allergies After you lift him to your stretch he does a big seizure arch, big sound and lauches into 1 min grand mal. followed by 5 min postictal and then more seizures. Vitals stable throughout transport. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 15, 2006 Share Posted February 15, 2006 ok, what are we supposed to answer now. IV, O2, monitor, give 5mg valium(or whatever antiseizure meds you have) and transport. There's not much more to do with this guy. Unless he codes There has to be more to this than what you posted but not sure what you want us to do with this. Link to comment Share on other sites More sharing options...
benanzo Posted February 15, 2006 Author Share Posted February 15, 2006 not much to do in the field.... but some seem to think we should dx cases like this so I'd like to here some people's ideas I should have said he was posturing from the get-go Link to comment Share on other sites More sharing options...
dors Posted February 15, 2006 Share Posted February 15, 2006 hmmm...... sounds like new onset epilepsy, or cva or maybe he hit his head without having outward signs he might have some kind of brain infection, he needs labs, ct all that his initial presentation doesn't necessarily tell me that he's been seizing all day, his aphasia and posturing says something like he's got an infection or possibly a tumor. I'd be willing to go with tumor Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 15, 2006 Share Posted February 15, 2006 new onset seizure Any fever? no evidence of trauma but could have a bleed from a bump on the hear a day or so earlier and then it manifested at work. I'd say no on the drug overdose but who knows Link to comment Share on other sites More sharing options...
Dustdevil Posted February 15, 2006 Share Posted February 15, 2006 How do we know he has no PMH, meds or allergies if he cannot communicate? SPELL CHECKED: No errors found. 8) Link to comment Share on other sites More sharing options...
medic5587 Posted February 15, 2006 Share Posted February 15, 2006 Did he respond to treatmeant? Like Dusty stated, history would be nice and you can't achieve one from the patient. Did it look like dystonia? Link to comment Share on other sites More sharing options...
benanzo Posted February 15, 2006 Author Share Posted February 15, 2006 yeah, I should have specified that one of the guys there was his half-brother who knew that he didn't have pmh. yes posturing was dystonic Link to comment Share on other sites More sharing options...
hammerpcp Posted February 15, 2006 Share Posted February 15, 2006 What do you mean exactly when you say posturing was distonic. From what I know distonia is twisting of the limbs and spasmodic movement, it doesn't describe one particular position/posture. Please enlighten me. Link to comment Share on other sites More sharing options...
benanzo Posted February 16, 2006 Author Share Posted February 16, 2006 it's the same thig, sometimes refered to as athetosis. his extremities were "posturing" in a way that closely resembled dystonia (dystonic posturing.) he had neurocystercicosis seen in CT. his ct was littered with calcified lesions....don't eat the pork in mexico. This is a CT similar to his. sorry this was kind of a dumb scenario, don't know where I was going with this. Link to comment Share on other sites More sharing options...
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