Paralysis

[chaser]

Sleddog asked that, it was 156.

[rocket]

He answers no to cancer and yes to neurological. His speech is becoming more clear and he says seizure. He also says, "Scared...can't move."

OK then. He appears to be an increasingly useful historian. Let's do a few more things to determine how we will be packaging this patient because I believe we will want to get rolling soon. I want to rule in/out the need for comprehensive spinal precautions. If we take a quick look inside the mouth can we figure out where the blood was coming from (bitten tongue or something more indicative of a fall/violent seizure/assault)? I understand he denies recent trauma and there is no obvious head trauma but I'd like to take a step back from the patient for just a moment and look at him and the context of the scene. Does it all add up to look as if he did NOT take a big spill onto his face, seize violently or get decked by a bar patron?

Let's take a quick look on his person for med ID tags, wallet info, etc. Do we find anything significant? A family member (# on a phone, etc) might be helpful to reach for the med history...

Let's do a quick check to see what the eyes can tell us. Are the pupils equal in size, reactivity to light, and accomodation? Do they seem about right in terms of size, etc in the context of the scene lighting (i.e., do the patient's pupils look about as dilated as those of my partner)?

What's the pulse (number and character)?

Let's ask a few more history questions. First the patient:

"You said seizure. Do you have seizures quite often?" If no, then "have you had any seizures before?"

And

"This thing that happened to you tonight...has anything like this ever happened to you before?" if yes it might be worth a shot to ask him "What did they say it was the last time this happened"?

Now I don't expect the underage girl to come along with us but if she is still around I'd like to know how much time the two of them spent together that day/what they did (maybe they ate somewhere, etc before coming to the bar), how much the patient had to drink/eat, over what period of time, and what he did/said (in as much detail as possible) right before he got up and walked away.

He may be 100% at room air now, but I want to take all the precautions possible if this is a neuro injury. Let's put him on 02 say 10L via NRB.

-Trevor

[AZCEP]

Sleddog asked that, it was 156.

I was pretty sure I had overlooked it.

[chaser]

Can we ask what meds he is on for the neuro condition (or any meds he is taking)?

Possible Todd's paralysis following seizure. Any confirmation from other sources he has never had a seizure before? I'm assuming the blood from mouth is due to him biting his lip or tongue but is there something that would show otherwise?

[JPINFV]

[/me remembers that we're supposed to be focusing on Hx]

Has this happened before? If so, under similar conditions?

Can he give any indication to what sort of neurological history that he has?

Has he ever seen a mental health professional?

[ERDoc]

Can we ask what meds he is on for the neuro condition (or any meds he is taking)?

Possible Todd's paralysis following seizure. Any confirmation from other sources he has never had a seizure before? I'm assuming the blood from mouth is due to him biting his lip or tongue but is there something that would show otherwise?

We have a winner. The guy has a seizure history and had a seizure. He is suffering from Todd's Paralysis which is a transient paralysis that occurs after a seizure. Usually it is not as diffuse as this guy has. Lots of good questions from everyone as ususal.