Quakefire Posted February 18, 2014 Posted February 18, 2014 Dispatched for 53 y/o Female pt. Fall not acting appropriately Time of Call 02:00 am Monday Morning You work for a rural ambulance service home hospital has basic emergency room with X-ray and labwork, time to scene approximately 20 minutes Dispatch info updated 15 minutes into response, Pt now has CP This scenario starts from arriving on scene
island emt Posted February 20, 2014 Posted February 20, 2014 (edited) OK : I'll play since no one else wants to start. Not acting appropriately how? Slurred speech? balance problems? memory loss? dysphagia? Altered mental status? Up at 2 am ::: why? what was she doing prior to fall? syncopy History? vitals ? new onset? Edited February 20, 2014 by island emt
Quakefire Posted February 21, 2014 Author Posted February 21, 2014 When you arrive the patients husband leads you in, the patient is sitting on the couch, appears quite lethargic, able to answer questions, but sometimes requires question to be asked several times, answers are short and slow. States dizzy when standing and walking, had to crawl up stairs to bedroom to wake husband, states plopped onto bed. No memory problems or dysphagia. Pt. states took 1 and a half 7.5mg Zopiclone tablets at approximately 21:30 and fell asleep on the couch. Pt, was woken up by 6/10 substernal chest pain, with both arms painful and numb. This was around 0100, family took about an hour to decide to call for an ambulance. No syncopal episodes prior to EMS arrival PMHx: HTN (Irbesartan), Hypothyroid (synthroid), hasnt taken meds since Saturday morning. Smokes approximately 1/2 pack a day Vitals: Pulse 48, BP 126/62, Resp Rate 18, SpO2 98% Pupils ERL Onset 0100
island emt Posted February 22, 2014 Posted February 22, 2014 Well that took a little research as we don't have Zopiclone in the U.S.. We do have a derivative in LUNESTA. Reading from a couple of drug sites for info on the drug , could she have taken alcohol with it? Is she sure it was only 1 & 1/2 pills? the side affect profile seems consistent with that presentation, including heart palpitations & bradycardia. Obviously you need to assess and rule in/out cardiac origin and treat as appropriate for S&S. I'd do a 12 lead and see what it shows along with a little O's and start a line just for insurance before transporting. Strictly anecdotal info::: My dealing with folks taking LUNESTA is they present as somnolent & whacked out in a deep almost coma type stupor. Zombie like almost. Had one pt that had gotten as far as their car and crashed in the woods along driveway. Absolutely no memory of anything since taking the drug 2 hours earlier.
Quakefire Posted February 22, 2014 Author Posted February 22, 2014 Daughter stated that the somnolence and CNS presentation is normal for patient when on this medication. I will post a 3 and a 12 lead in the morning probably because I don't have them with me at the moment Sent from my iPhone using Tapatalk
HellsBells Posted February 23, 2014 Posted February 23, 2014 What about the fall in the dispatch notes? Is this relevant, or did she just slide off the couch? Allergies? Pill bottles? lets make sure that there are no extra pills missing BGL?
Quakefire Posted February 24, 2014 Author Posted February 24, 2014 No allergies known, Zopiclone is a PRN medication but no excessive amount of medication is missing from the bottle (not empty and refilled two days ago kinda thing) Dose taken is normal and listed on bottle. Fall described as "plop" on the bed BGL 6.8 mmol/L (122.4 mg/dL) 1
Quakefire Posted February 24, 2014 Author Posted February 24, 2014 Oh and here is the requested 3-lead and 12-lead
Just Plain Ruff Posted February 24, 2014 Posted February 24, 2014 I'm no expert, but that sure looks like elevation in 2 3 and aVf and I'm thinking that we might want to begin to be a little more agressive with this lady. Sounds like a MI induced vagal plop to the bed.
paramedicmike Posted February 24, 2014 Posted February 24, 2014 I'd call a STEMI alert based on the EKG. Start a cardiac work up (continue to monitor, IV, O2 etc...) and draw bloods (CBC, chem, trop). Any chance, since the home hospital is a small community ED setting, they have any cardiac resources? Or is this patient getting transferred? How far to the closest cath lab? Can the patient be flown?
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