TechMedic05 Posted April 21, 2006 Posted April 21, 2006 Anything significant on a brief assessment? FS was alright, abdominal mass? skin lesions? febrile/ cold? pupils? Associated vomiting? Anyone in her family know of her past medical history? Airway managment in the immediate time would be beneficial, but I'd think we're still a bit hasty for RSI considerations as of yet.
akroeze Posted April 21, 2006 Posted April 21, 2006 Hit her again at 360. One shock obviously didn't convert her full body fibrillation.
chbare Posted April 21, 2006 Posted April 21, 2006 Did she take or is she taking malaria prophylaxis medications.(Hx. of living in Central America) Seizures have been reported with people who have taken Chloroquine. Check her temp. when we get her life threats stabilized. "How long was she out of the country? Rashes, petechia, purpura, skin discolorations?" Excellent question AZCEP. Let us go over some of the diseases from that region of the world, forgive all this typing I am just trying to go other the common disorders to try to rule out other causes. Thinking out loud. Chagas Disease- Heart failure (I do not think this is the problem) Malaria- Fever, Chills, Feel Like poop (Probably not related to sudden onset seizures) Typhoid/Cholera/HEP A/E coli ( No HX of N/V/D, probably not related to sudden onset seizures) Rabies (Seizures can occur with Rabies, any other S/S of rabies prior to the seizure?) TechMedic05, I agree, if we cannot stop the seizure her brain is toast from hypoxia. Have the RSI equipment ready. Take care, chbare.
ERDoc Posted April 22, 2006 Author Posted April 22, 2006 There is no petechiae or rashes and she is afebrile. The only known history that the family is aware of is a positive PPD when she went to the doctor recently. She was born in Central America and moved to the US about 3 years ago. Other than the shaking, her exam is pretty unremarkable.
The Hook Posted April 22, 2006 Posted April 22, 2006 Everything I have read has covered the basics. Point of interest: my wife had a seizure as an allergic reaction to a drug called Ultram. I am not an expert on this drug though I believe it is a combo analgesic/anti-inflamatory. She had only the one and it was a classic grand mal seizure. We know that a seizure death is a hypoxic death. Concentrate on the airway and administer Benzo's as your protocol allows. Good luck! Kevin
AKmedik8or Posted April 22, 2006 Posted April 22, 2006 Question to the family as to the need for the PPD test, consider etiology seizure due to spinal TB metastasized to the CNS. What was the EKG? Consider CVA family Hx Parasitic infestation alcohol with drawl poly-pharmacological OD. Increasing / repeating benzodiazepine treatment without considering RSI, RSI increases the risk to the Pt without controlling the seizure the CNS is still in seizure, without an further information to the Hx of etiology of the seizure there is a risk of an under laying myopathy that would leave the Pt paralyzed, evaluate the Pt for hyperthyroid by medication list or prior medical complaint through family interview and hyperkalemia through EKG. Suction the airway position Pt and eval SpO2 and increase benzo dose
TechMedic05 Posted April 22, 2006 Posted April 22, 2006 chbare- By airway management I meant for the immediate issue, to control the airway primarily BLS...NPA, BVM if necessary. RSI at this point is a stretch, I feel. And, as mentioned, RSI does not stop seizures, only the appearance of seizures. Perhaps even in a seizure patient it would be a good assessment finding to know if and when the seizure activity is abolished, if it ever happens. We can never know that if the patient receives a paralytic. [Well, Succs. is only for 3-6 minutes, but then there's the sedation issue with someone who we can not control seizures with, and some services have Roc. or vec for long term paralyzation] Theoretically, if lucky enough to have good compliance, and air movement, an aggressive BLS airways treatment may be, I believe, more appropriate. just my $0.02 Doc - curiosity: pupils? Provided no quinine poisoning. And vitals for kicks and giggles. Medik8or, kinda agreeing wih you as the TB meningitis as a stong ddx.
Ridryder 911 Posted April 22, 2006 Posted April 22, 2006 Good points AKmedik8or; however I disagree with your action. Yes, there is a chance of hyperkelemia but, I might choose another paralytic other than Sux., that does not a high effect K+ shift .. I would highly recommend using some form of benzo or CNS agent to depress the clonic movements and secure the airway. If the sz activity continues, such as nasal versed, etc.. This is of course status occurs.. The usual neuro hx. questions, fever, trauma, illness in which you might want to re-literate. As well any "special pets".. or plants/herbs ?.. such as spiders, snakes & all those things that makes my skin craw.. since they too carry neuro toxic agents as well... Be safe, R/r 911
chbare Posted April 22, 2006 Posted April 22, 2006 Is she currently taking any medications. I know Cycloserine can cause seizures. CNS TB can result in seizures as stated earlier in this thread. We may need RSI to secure an airway if we cannot control seizures with benzo's. May consider general anesthesia meds if in a more secure environment. Load her with Cerebyx if indicated, however, we need to focus on stopping the seizure at this time. If she is hyperthermic, we can give rectal APAP if indicated. And I would like to put a mask. Take care, chbare.
Ridryder 911 Posted April 22, 2006 Posted April 22, 2006 I agre with the mask & decon room.. once we can get the seizures to stop a CT would be nice, then maybe later on a LP.. after some more labs...might as well have lab, just bring everything down...LOL R/r 911
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