Be wary of pt LOC

TheMowingMonk

TheMowingMonk

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So me and my partner roll up on a call to a nursing home. pt's chief complaint of elevated temp x 2 days with no relief after to 650mg doses of tylenol . I go into the room and start assessing the pt while my partner got started on the paperwork. the pt was in bad shape, temp of 103, bad parkinsons, bed sores all over the place, NG tube, on dyalysis, etc. after talking to my pt even though he was in bad shape he was still A&Ox3 and responsive to questions and could talk. So while im grabbing a BP my partner walks in an sees the large pressure sore on the side of the pts face (which the pt was unaware of) and my partner thinking the pt is totally out of it point at the guys face and says "eww what is that on his face the looks gross" and preceeds to turn around and walk out of the room causing my pt to freak out looking at me wondering what was on his face. after calming him down and explaining about the pressure sore we get him on the gurney, only then does my partner realize the pt is pretty with it after my pt preceeded to chew my partner out for scaring him which is what i found amusing, might have been more funny to be there, but it was interesting. moral of the story, never assume anything!
 
This is funny. Although at this point in our class, they are teaching us to be careful what we say. It has been proved that sometimes even when pt is unconcouse they can hear what you are saying.
 
had something similar when i was on a clinical for medic school. long story but amusing and a lesson well learned.

I was doing an ER clinical rotation. and EMS had brought in a 17y/o female from school who had "blacked out".. ok, simple enough or so i thought. EMS brings her in after friends at school tell them they were walking down the hall when she got dizzy and passed out. the history the medics got was the night before she was riding a 4 wheeler with her boyfriend not wearing a helmet and was thrown. so they had her in full TSI. O2 via NRB, IV of N/S TKO, and all V/S were WNL. they did the coma cocktail. Narcan, thiamine, glucose...... no changes...... ok they arrive at the ER, after giving the report and swapping the patient to the ER bed. the doc comes in does his assessment. says repeat the narcan...... no changes. ok now give some flumazinil. (benzo OD antidont) no change..... hmmm. no evidence of trauma. we inspected every inch of this girl nothing. not even a pimple. no signs of siezure, nothing. 100% completly unresponsive. doc says cath her for a urine tox screen. nurse caths the girl. and states she is a virgin. with 0 responce to the cath. urine collected and sent to the lab.

she has a GCS of 6-7 if i am remembering correctly. doc says ok. lets get a CT of her head / neck. results were all normal. 0 abnormalities. Doc is like hmmm. well Mr student. any suggestions? im like not a clue at this point. i say could she be faking? he says possibly but doubtfully, he reminded me there was 0 response the the urine collection.....
OK Mr student. with a GCS of 7 or less what do you need to do? i say intubate. he says correct. so do it. ok. crap she has a gag reflex.... we will need the succs. and norcuron. doc say ok, RSI her then.

now mind you this is a large level 1 trauma center that is also a teaching hospital. so the room was full of people.

we give her:
5mg versed.
1.5mg/kg succinylcholine

I intubate 0 complications /CHEER first live PT intubation!!!!!!!!!!!

everyone in the room starts reviewing other possibilities like drug OD or faking or the trauma or anything.........

we then give her 0.1mg norcuron. Doc goes out and is confiering with other docs for the root of the problem. orders a versed drip to be hung to keep her sedated. mind you 30 - 45 min have passed since the intubation.

The nurse in charge of this pt and I go in to hang the drip and see her starting to rouse. we call the doc in. he is like hmmm interesting. we all continue to watch her. she is starting to become more and more conscious. Doc is like Well. you intubated her. extibate her. OK. I do it.she starts coughing. and more awake. by now the room is full again. PT is fully awake. looking at us like who are you and why am i here? she says first off. I am not a druggie, and I am not a dramma queen. All I remember is you guys gave me some medicine and I could not breath anymore, then (looking DEAD at me) you (pointing at me) put a tube in my throat and I could breath again.


Talk about sending chills down your spine. I remember hearing the stories of PTs hearing stuff or remembering stuff but not witnessing it first hand. and to this day I will always remember that.

BTW. the girl tested positive for GHB poisioning. they arrested 3 male students in a later investigation.

she has since made a full recovery and last i heard is doing quite well.
 
I had something funny happen along the lines of that as well. (I'm an ED tech) There was a LOL that came in from a local SNF one night to the ED... She was pretty out of it-- not responding at all to our feeble attempts to awaken her to find out the Chief complaint and to get the medical hx(Medics warned that she was severely demented and had Alzheimers).
I was getting initial vitals with another ED tech standing next to me chatting with me, suddenly as the BP cuff reaches max capacity on her arm--she shoots straight up in bed, turns to the ED tech next to me and punches her dead-on in the stomach! I having witnessed everything just about died laughing... I told my co-worker "I guess she's just really good at playing Possum then..Ahahahaha!!"
Whenever I see her at work, I still give her a hard time about it :)
 
EMT-P633 said:
had something similar when i was on a clinical for medic school. long story but amusing and a lesson well learned.

I was doing an ER clinical rotation. and EMS had brought in a 17y/o female from school who had "blacked out".. ok, simple enough or so i thought. EMS brings her in after friends at school tell them they were walking down the hall when she got dizzy and passed out. the history the medics got was the night before she was riding a 4 wheeler with her boyfriend not wearing a helmet and was thrown. so they had her in full TSI. O2 via NRB, IV of N/S TKO, and all V/S were WNL. they did the coma cocktail. Narcan, thiamine, glucose...... no changes...... ok they arrive at the ER, after giving the report and swapping the patient to the ER bed. the doc comes in does his assessment. says repeat the narcan...... no changes. ok now give some flumazinil. (benzo OD antidont) no change..... hmmm. no evidence of trauma. we inspected every inch of this girl nothing. not even a pimple. no signs of siezure, nothing. 100% completly unresponsive. doc says cath her for a urine tox screen. nurse caths the girl. and states she is a virgin. with 0 responce to the cath. urine collected and sent to the lab.

she has a GCS of 6-7 if i am remembering correctly. doc says ok. lets get a CT of her head / neck. results were all normal. 0 abnormalities. Doc is like hmmm. well Mr student. any suggestions? im like not a clue at this point. i say could she be faking? he says possibly but doubtfully, he reminded me there was 0 response the the urine collection.....
OK Mr student. with a GCS of 7 or less what do you need to do? i say intubate. he says correct. so do it. ok. crap she has a gag reflex.... we will need the succs. and norcuron. doc say ok, RSI her then.

now mind you this is a large level 1 trauma center that is also a teaching hospital. so the room was full of people.

we give her:
5mg versed.
1.5mg/kg succinylcholine

I intubate 0 complications /CHEER first live PT intubation!!!!!!!!!!!

everyone in the room starts reviewing other possibilities like drug OD or faking or the trauma or anything.........

we then give her 0.1mg norcuron. Doc goes out and is confiering with other docs for the root of the problem. orders a versed drip to be hung to keep her sedated. mind you 30 - 45 min have passed since the intubation.

The nurse in charge of this pt and I go in to hang the drip and see her starting to rouse. we call the doc in. he is like hmmm interesting. we all continue to watch her. she is starting to become more and more conscious. Doc is like Well. you intubated her. extibate her. OK. I do it.she starts coughing. and more awake. by now the room is full again. PT is fully awake. looking at us like who are you and why am i here? she says first off. I am not a druggie, and I am not a dramma queen. All I remember is you guys gave me some medicine and I could not breath anymore, then (looking DEAD at me) you (pointing at me) put a tube in my throat and I could breath again.


Talk about sending chills down your spine. I remember hearing the stories of PTs hearing stuff or remembering stuff but not witnessing it first hand. and to this day I will always remember that.

BTW. the girl tested positive for GHB poisioning. they arrested 3 male students in a later investigation.

she has since made a full recovery and last i heard is doing quite well.
Click to expand...

That's F'in AMAZING! Great Share.
 
I learned early.

Transporting long time post-CVA patient from NH to hospital. Every ten seconds or so she loudly calls out, in a reedy voice, "HELP!". About ten minutes into the ride, after trying to calm her and not seeing any expression change or head turning despite her eyes being open, I ask her a question.
"Ma'am, what's wrong?".
"HELP!. Nothing. HELP!".

Yikes. She was alert, oriented to her name and day of the week, but her internal call light was stuck "ON".
 
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