EMS_Cadet Posted June 13, 2006 Share Posted June 13, 2006 You are dispatched to a private residence for an unknown medical. Dispatch advises the patient is a 33 year old female. Upon arrival you find a private residence. Scene appears to be secure from the outside. No hazards spotted. You walk to the front door. You knock on it. A older male answers the door. He says, "she's in the kitchen". You follow this man to the kitchen. You enter the kitchen and see a 33 year old female laying on the floor. She is alert, but not very oriented. You smell feces and note the presence of fecal matter on the floor. Your patient is extremely sweaty and is drooling out of her mouth. The patient states that she has "blurry vision". All the sudden, your patient begins to have a grand mal seizure. Let the GAMES begin! :twisted: Link to comment Share on other sites More sharing options...
nsmedic393 Posted June 13, 2006 Share Posted June 13, 2006 I want a better story. Interview the guy that opened the door. Ask his relationship to her, what happened, her pmhx, her medications and all that good stuff. As it sounds right now, Quick set of vitals, IV and possibly some valium depending on what the history reveals. Link to comment Share on other sites More sharing options...
EMS_Cadet Posted June 13, 2006 Author Share Posted June 13, 2006 I want a better story. Interview the guy that opened the door. Ask his relationship to her, what happened, her pmhx, her medications and all that good stuff. As it sounds right now, Quick set of vitals, IV and possibly some valium depending on what the history reveals. The male who answered the door explains to you that he's her boyfriend. They have been going out for almost 4 years now. They recently went on a cross county trip as a vacation. John (the boyfriend's fake name) explains that they has just got done eating dinner. The girlfriend is a vegetarian, so she made herself a vegetarian dish. John says she is in perfect health. No medical problems. She only takes Zyrtec for allergies. She has no allergies. John explains that the two had already finished eating and were just sitting and talking at the table when his girlfriend become suddenly ill. She had a very upset stomach, blurred vision, profuse sweating and even started coughing. She started to stand up and she fell on the floor. John says that she "went on herself". John explains that he doesn't think she contracted anything during the cross country trip because she was just seen by her regular doctor for a physical. Upon assessment, you note audible wheezing, dyspnoea, bronchial secretions and excessive lacrimation. The seizure lasted only 10-15 seconds. Patient is no longer seizing. BP: 102/60. RR is 17. HR is 52. Temp is 98.1. Link to comment Share on other sites More sharing options...
rocket Posted June 13, 2006 Share Posted June 13, 2006 I take it the couple did not eat the same thing for dinner? Let's hear a little more about what she ate. In the meantime let's get her head/upper body elevated (being mindful that more sezires may occur) and go 02 via NRB ...and get the nasal airways handy. -Trevor Link to comment Share on other sites More sharing options...
EMS_Cadet Posted June 13, 2006 Author Share Posted June 13, 2006 I take it the couple did not eat the same thing for dinner? Let's hear a little more about what she ate. In the meantime let's go with 02 via NRB and get the nasal airways handy. -Trevor John ate a steak, while the girlfriend had the vegetarian dish. The dish contained: Green Peppers. Tomatoes. Squash. Mushrooms (assorted). Brockley. Yellow peppers. It was all on top of steamed rice. Link to comment Share on other sites More sharing options...
medic001918 Posted June 13, 2006 Share Posted June 13, 2006 I want to know a little more about what she ate as well. Did she make something new that she hadn't eaten before? As far as management of the seizure, I'd give versed IM or ativan IV depending on if she had access. The story is consistent with a seizure, but we have to figure out why. What do her pupils look like? Is there any indication of a bleed? Any chance of any head trauma during their trip? As far as care and management of the patient, high flow oxygen via NRB, suction the airway of the secretions if needed. At the minimum this patient is a candidate for an NPA, possibly a candidate for intubation if she continues to seize. Secure IV access to allow for medication administration and definatly monitor the cardiac rythem for any underlying rythem disturbance. My guess is there's more to the story then what the boyfriend is letting on. Also, let's not forget to consider some spinal immobilization precaution. She did fall due to a suspected seizure and she's not totally oriented which in my PSA rules out the ability to clear her c-spine. Shane NREMT-P Link to comment Share on other sites More sharing options...
rocket Posted June 13, 2006 Share Posted June 13, 2006 Thanks for the info. How do her pupils look? Maybe organophosphate/carbamate insecticide poisoning? -Trevor Link to comment Share on other sites More sharing options...
EMS_Cadet Posted June 13, 2006 Author Share Posted June 13, 2006 I want to know a little more about what she ate as well. Did she make something new that she hadn't eaten before? As far as management of the seizure, I'd give versed IM or ativan IV depending on if she had access. The story is consistent with a seizure, but we have to figure out why. What do her pupils look like? Is there any indication of a bleed? Any chance of any head trauma during their trip? As far as care and management of the patient, high flow oxygen via NRB, suction the airway of the secretions if needed. At the minimum this patient is a candidate for an NPA, possibly a candidate for intubation if she continues to seize. Secure IV access to allow for medication administration and definatly monitor the cardiac rythem for any underlying rythem disturbance. My guess is there's more to the story then what the boyfriend is letting on. Also, let's not forget to consider some spinal immobilization precaution. She did fall due to a suspected seizure and she's not totally oriented which in my PSA rules out the ability to clear her c-spine. Shane NREMT-P She has made this dish before, but without this new type of mushrooms. She found these on her cross country trip. Pupils are pinpoint. No indication of a bleed. No head trauma during the trip. Monitor shows Sinus Brady @ 50 with no ectopy. Link to comment Share on other sites More sharing options...
rocket Posted June 13, 2006 Share Posted June 13, 2006 Pinpoint and brady? I think I'm gonna stick with my notion of insecticide poisoning. Let's put dinner in the bag to take with us (not for leftovers) and get rolling. I want to call med/poison control soon. -Trevor Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 13, 2006 Share Posted June 13, 2006 She has made this dish before, but without this new type of mushrooms. She found these on her cross country trip. Pupils are pinpoint. No indication of a bleed. No head trauma during the trip. Monitor shows Sinus Brady @ 50 with no ectopy. Obviously more about the mushrooms, but my gut tells me thats not it. Unless they are the magic mushrooms my buddies used for pizza back in the day. Somethings missing on this story... Link to comment Share on other sites More sharing options...
Recommended Posts