Unusual call ( at least for me )

[spenac]

I had a call that not sure what to call it. Weekend rent-a-doc at the ER no help, didn't have a clue. Here's what I had maybe you've seen this before and no big deal. Thanks for your input.

Female early 30's. Call patient unresponsive no pulse. Arrived found patient Alert and oriented but a little slow on response.

Approx vitals:

Resps 16 regular

pulse 70 reg

O2 98% room air

BP 130/70

ECG Normal sinus

Blood glucose level 100

Pupils equal reactive

Hx of anxiety on Prozac

NKDA

No drug use, only an occasional drink

good motor function, no trauma, no edema, not pregnant, not menstruating ( LMP about 2 weeks ago )

Family said she was walking into the room then said I can't see anything. Family member got to her as she collapsed. Could not locate pulse or hear heart beat. Was about to start CPR when patient had a loud breath and they then found pulse. They said patient had only woken up about 2 minutes prior to our arrival. Response to scene about 10 minutes.

Transporting patient. About 20 minutes into transport patient developed mild headache but was alert and oriented talking normal and then just stopped. No response to voice or pain (sternal rub, eye pressure points) Hand dropped on face so more than likely not faking.

Vitals all stayed basically the same as above except Pupils dilated non reactive, jaw locked, eyes rapidly twitching, rest of body relaxed. Pulse and resp stayed same. Airway patent and self maintained. After 6 minutes started waking up. This happened again about 20 minutes later basically same thing. On arrival at hospital alert and oriented.

Rent-a-doc says not a seizure, but he had no idea of cause. Have not found out if anyone figured out cause yet. What do you think? Any ideas? I'll check with her family when I see them to see what the doctors finally decided.

[katbemeEMT-B]

I would guess a seizure. While the different types of seizures have common denominators their symptoms can vary. I attended a recent conference in which a neuro doc from the Mayo Clinic in Rochester, MN spoke on seizures. He explained to us that sometimes their is no clear cut reason for the seizure and only extensive neurological testing can confirm that it was a seizure and even then if it was an isolated episode they may never be able to confirm it. We have had two such cases in my area. They didn't present as a normal seizure would have. One patient has not had another episode and it's been over a year. The other was diagnosed with adult onset epilepsy. He is a frequent patient of ours as he often develops resp distress following his seizure.

Let us know what you find out if you do.

[AnthonyM83]

Possibly just a syncopal episode... Family might have had trouble locating a pulse in their panic.

While at the hair stylist the other day, the patron (21, male) next to me passed out. The stylist said he was having a seizure, there was some muscle tensing, but he came around pretty quickly, not post-ictal, and said he used to faint as a child when he was cut (I heard stylist apologizing for nicking his ear just a few minutes before), he termed the events seizures, but took no seizure meds and said the feeling up to the point he lost consciousness felt like the events that happened as a child. On arrival of medics, pulse was 70, BP 130/somethingregular...pt, ER nurse (also getting haircut), and responding medics all believe it was a syncopal as well.

Though, I have to say 6 minutes is a little longer than normal for what I've seen. Headache is common afterwards, though, as is feeling lightheaded again as if it's going to reoccur...in your case it might have during transport. Plus your pt had a hx of psych.

I don't know, though. Was there any nausea?

[8151]

Probably PID. NRB@15Lpm, B/L 14g with saline wide open,transport hot. Consider Narcan. Pt. may also be CVA/TIA.

[ericenglund]

I want to say some type of seizure too but then again I don't. and it happened three times and she was alert&oriented in between them.. hmm

Was the "eye twitching" the same as you'd see on someone who'd been sedated with ketamine or how would you describe it?

How much prozac was she on/did she take? I'd want to get more into that.

[JCicco345]

I'd go with sz. Can't be a syncopal, syncopals are short loc, this was extended.

[ericenglund]

Probably PID. NRB@15Lpm, B/L 14g with saline wide open,transport hot. Consider Narcan. Pt. may also be CVA/TIA.

that much oxygen and dual 14g ivs and narcan??

i know i havent been a medic for too long but sheesh

[JCicco345]

I don't know about the b/l 14's, vitals seem pretty stable. BUt i'm just a student.

[scope2776]

i was thinking seizure too...

what was the doc's rationale for not calling it a seizure? did she have repeat episodes in the ER?

maybe something pysc/stress related? i dunno... a stab in the dark....

did she have a fever or feel warm? no cardiac history?

[Dustdevil]

Probably PID. NRB@15Lpm, B/L 14g with saline wide open,transport hot. Consider Narcan. Pt. may also be CVA/TIA.

LMAO!

That's funny right there! I don't care who you are!

So was this patient by chance a nursing student?

I used to do that all the time when I was in nursing school. 8)