tcripp Posted December 2, 2011 Posted December 2, 2011 What about leading up to the events...has he been ill lately? Again, what's his temp? I asked about PMH wondering if he was diabetic and that 94 was relative for him... Has this specific event occurred before? And, did I miss it? How old is your patient?
Kaisu Posted December 2, 2011 Posted December 2, 2011 Hypertensive encepalopathy ? Did the delirium/stupor accompany rapid rise in BP, with increased LOC when BP was lower?
nypamedic43 Posted December 2, 2011 Author Posted December 2, 2011 patient is 41 years old, hasnt been ill but has been stressed. his temp was normal 98.4 I think the nurse said. wife was unable to give me details about the breakdown in '98, just that he had one. CM the BP was 150/100 when he was awake and the 142/90 was when he was out
Kaisu Posted December 2, 2011 Posted December 2, 2011 OK.. now I am going to work on the differential for delirium. was the patient in pain? Were CT scans of head, urinary tract performed? What did they show? has the patient untreated syphilis? Is the patient a long term alcoholic? Was a spinal puncture done? .. and I am not ruling out TIA/CVA.. just don't think it's likely based on the title of your post PS.. as far as I can tell, this is the differential Common causes: Dementia – nope – not long standing Pain – not sure – was the patient in pain Stroke/cerebrovascular accident and transient ischaemic attack – as suggested by your title, but unlikely because suggested by your title Myocardial infarction – normal 12 lead – still possible Acute systemic infection – patient afebrile Hypoglycaemia- nope BGL 94 Hyperglycaemia – nope – as above Hypoxia – I'm assuming because blood work was normal, arterial blood gases were too Hypercarbia - nope as above Acute urinary obstruction - possible Medication- or illicit drug-related – possible but not likely from your on scene assessment Alcoholic ketoacidosis – nope – blood work again Hepatic encephalopathy – nope – normal hepatic and renal numbers Renal failure – nope (blood work) Hypernatraemia – nope (blood work) Hyponatraemia – nope (blood work) Hypercalcaemia – nope (blood work) Meningitis/encephalitis – possible. Did the patient get spinal Brain tumour – possible – what did the CT show Post-ictal state – no seizure history – but possible new onset secondary to a lot of things Uncommon Traumatic head injury – any signs of trauma ? Adrenal crisis– nope (blood work) Thyrotoxicosis – nope (blood work) Myxoedema – nope (blood work) Brain abscess – possible – what did the CT show Neurosyphilis – has the patient untreated syphilis? Wernicke's encephalopathy – is he a long term alcoholic?
Vorenus Posted December 2, 2011 Posted December 2, 2011 Can you go any further into those phases of unconsciousness? How was his ecg during them?How long did they take?
nypamedic43 Posted December 2, 2011 Author Posted December 2, 2011 CT was normal. No lesions, bleeds or masses. No alcohol use. Patients ECG was normal during the periods of unconsiousness. They lasted as long as I let them. ie: sternal rubs and yelling at him to wake up. Periods of being awake lasted a minute or so before he passed out again. I gotta tell ya this guy had me stumped and asking what else I could do for him. Luckily transport time was about 5 minutes and we were on scene with him about 7 or 8...so 12 or 13 minutes from time of call to delivery at the ED.
ERDoc Posted December 2, 2011 Posted December 2, 2011 Could you tell us a little more about the meds? What allergy medcine did he take? How much? What meds were in the bathroom? Is anyone else sick?
hatelilpeepees Posted December 2, 2011 Posted December 2, 2011 I would lean towards TIA, but as others have said, since you lead with that in the title, I am guessing that is not the case. My second guess would be psychological since he has fairly normal vital signs. Third guess would be medication reaction (allergy meds). Fourth would be that he is taking something for his stress that you were not told about (legal med, illegal something, or alcohol). Fifth I would retest the glucose from the other hand and make sure that reading was correct. Lastly I would consider a seizure disorder, but I do not recall you stating that any activity was witnessed or if the patient was incontinent.
Kaisu Posted December 2, 2011 Posted December 2, 2011 Patients ECG was normal during the periods of unconsiousness. Now that is an interesting statement. What was his ECG when he was conscious?
romneyfor2012 Posted December 2, 2011 Posted December 2, 2011 (edited) I vote Psych issues since his unconsciousness was alleviated by sternal rubs. Edited December 2, 2011 by romneyfor2012
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