chbare Posted May 5, 2006 Share Posted May 5, 2006 You are called to an inpatient psychiatric unit for a 63 year old male having seizures. What would you like to know? Take care, chbare. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted May 5, 2006 Share Posted May 5, 2006 You are called to an inpatient psychiatric unit for a 63 year old male having seizures. What would you like to know? Take care, chbare. Gah, let me take a stab at it, since I feel I've been forgetting everything since my NR exam with no practice and no job yet. I'd like to know how long he's been seizing, what he was doing right before, if he has a history of seizures, medications, recent medication changes, whether he's been taking them, any history of violence or faking medical conditions, "what he's in for" at the psych unit, what's normal seizure time if he has had them before, any other medical problems or recent medical history...from bystanders. What's the condition of the room? No dangers, right? Any other injuries visible? I guess for now I'd just try to maintain an open airway, monitor breathing and pulse (if possible), while not actually physically restraining him, and consider administering O2. Link to comment Share on other sites More sharing options...
chbare Posted May 5, 2006 Author Share Posted May 5, 2006 The scene is secure and you are met at the door of the lock down unit by the patients Nurse. She tells you that the patient is a known schitzophrenic that has auditory and visual hallucinations he has been off of his meds and was admitted having hallucinations and behaving violently. The Nurse tells you that the patient has no allergies, no history of a seizure disorder, and no surgical history. He was given an injection of Haldol about an hour ago then developed what the Nurse thought were seizures. General impression finds the patient supine on the floor without evidence of trauma. You do not notice any tonic clonic activity, but the patient appears to be very stiff and board like. He has snoring and shallow respirations at about 10 per minute. He has a weak thready radial pulse at about 110. His skin appears flushed and feels hot to the touch. His eyes are closed but he moans and grimmaces with painful stimuli. What else would you like? Take care, chbare. Link to comment Share on other sites More sharing options...
hammerpcp Posted May 5, 2006 Share Posted May 5, 2006 Assist ventilation's. Apply monitor and SPo2. BG. Vitals? Any other PMHx? Duration of current condition? And what do you mean she "thought they were seizures"? if i am skeptical about her ability to recognize a seizure i would ask her to describe the Pt's presentation in detail. Incontinence? Link to comment Share on other sites More sharing options...
ERDoc Posted May 5, 2006 Share Posted May 5, 2006 Has the pt ever been given Haldol before? How hot is hot (get a rectal temp)? I suspect that this pt has a syndrome that is probably malignant, but I guess we'll see. Link to comment Share on other sites More sharing options...
AZCEP Posted May 5, 2006 Share Posted May 5, 2006 Ratcheting biceps tendon? Oculogyric crisis? dystonic contractures? 25 mg Benadryl coming up. Link to comment Share on other sites More sharing options...
hammerpcp Posted May 5, 2006 Share Posted May 5, 2006 Botox injections? Link to comment Share on other sites More sharing options...
hammerpcp Posted May 5, 2006 Share Posted May 5, 2006 Is he supposed to be on tricyclic antidepressants? This is a great scenario BTW. Link to comment Share on other sites More sharing options...
chbare Posted May 5, 2006 Author Share Posted May 5, 2006 Sorry I did not post earlier, I worked last night and slept in a little. Thanks ERDoc for not giving it away. No Botox injections, he has received Haldol in the past without problems, no Hx. of TCA use, 02 Sat on room air is 86%, BGL-129mg/dl, B/P-80/44, Pulse-110-130 and weak, and a rectal temp is 105.3 F. The nurse is a new grad LPN and stated that about an hour after giving the Haldol injection she found the patient like this, she thought he might have had a seizure and called 911. You insert a nasal airway and begin PPV with a bag valve mask at 15 LPM, you note there is a lot of airway resistance and it is very difficult to bag the patient. Anything else? Take care, chbare. Link to comment Share on other sites More sharing options...
Dustdevil Posted May 5, 2006 Share Posted May 5, 2006 How hot is hot (get a rectal temp)? Word. This is not likely to be your garden variety seizure. We've got a whole syndrome going on here that is serious. Regardless of the etiology, and regardless of what your cookbook says, think this one through logically and you'll do good. Link to comment Share on other sites More sharing options...
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