"It was the wierdest thing..."

[wwrescueEMT]

I was on a call recently with the volunteer department i'm on where the only thing anyone on the crew could really say after it, or when describing the scenario to anybody was, "it was just the wierdest thing."
We got paged out for an unresponsive male patient out near the edge of our area, a good 10-15 minutes away. One of our first responders out in that area went to the scene and called us with updates that the patient was "unresponsive, vomiting, facedown. Get here as fast as is safe and get the paramedics here now." So we page out some nearby paramedics as we race to the scene. As we get on scene, I see that our first responder has the patient on his back, with an oral airway in place and is bagging the patient. Says he found him facedown, we have no history other than that the same first responder had been out there the year before for some psychological problem, no meds, he didn't smell like booze, no family on scene or anything. We grab the guy and get him in the back of the ambulance (along with a million and a half mosquitoes). The guy is vomiting and just keeps vomiting, so we're alternating with suctioning and bagging. His BP and pulse are elevated, sp02 is in the 80's and he's unable to maintain his airway, so we did an iv and combitubed him. We went to assess mental status again and to our shock he opens his eyes and looks right at us! Doesn't move, doesn't have a gag reflex, never once made a motion as if he were trying to pull out the tube, he just looked at us. And you could see in his eyes that he wasn't just looking at us...he actually saw us. We had no idea what was going on with him. BP and pulse were coming back down to normal and the sp02 went up to 100 with the combi in place. Once the paramedic jumped on board he took one look at what was going on and we showed him that the guy would look at you when you called his name. The paramedic had no idea what was going on either, he just sat back and said that there was nothing he could do that we hadn't already done.
We rolled into the hospital and showed the doc and nurses our guy and they had never seen anyone who would look at you, even though they had a tube down their throat either. It really was the wierdest thing...

An hour later the paramedic called me and said that the guy had a BAC of .511. He didn't smell like alcohol at all. Our first responder is a cop. None of us had any idea.

 

[medic_chick87]

...doo doo doo doo...:unsure:

Dude, thats totally trippy! Kinda cool though. Were you able to ask any hx questions and have him answer with his hands?

 

[mycrofft]

CNS insult or tox?

Interesting. Such behavior was reported for instances of cervical spine severance (guillotine, or medical experiments with animals mostly in the USSR), but of course they did not survive to answer follow-up questions...and were not vomiting (no stomach). Something paralyzed your pt, or the brain was essentially uncoupled from the rest of the body. Wonder if he had intracerebral injury, other drugs or botanicals on board, or C spine damage?

PS: ever notice that we hurriedly turn people on their backs and often their airway goes to hell when supine?

 

[mikeylikesit]

.511.....and he lived? How? i had a ton of guesses of what it may have been until i saw his BAC. wow.

 

[mycrofft]

Good old Wikipedia, about blood alcohol levels.

QUOTE:
"[edit] Effects at different levels
See also: Short-term effects of alcohol

Unless a person has developed a high tolerance for alcohol, a BAC rating of 0.20% represents very serious intoxication (most first-time drinkers would be unconscious by about 0.15%)[citation needed], and 0.35% represents potentially fatal alcohol poisoning. 0.40% is the accepted LD50, or lethal dose for 50% of adult humans. For a long-time, heavy drinker, those numbers can at least double. In extreme cases, individuals have survived BACs as high as 0.914"
CLOSEQUOTE

NOTE: That was "survive", not "enjoy"!

No idea about what could yield an inaccurate BAC except mixing up specimens, reporting a serum level as a blood level (serum level can be very much higher than the whole blood one) or someone used an alcohol wipe to draw the blood. Where we draw forensic tests we don't even HAVE alcohol products, just betadine.

 

[mikeylikesit]

if it wasn't the elavated BAC then i would have ventured that he was Cataplexic.

 

[firetender]

Regarding his lights were on, somebody was home, yet, there was no reaction to the invasive therapy...the guy was stoned. Deeply. I don't say this in jest. During certain traumatic instances some people literally "leave their bodies"

The wonder isn't that he left, the wonder was that he chose to come back.

 

[Onceamedic]

No idea about what could yield an inaccurate BAC except mixing up specimens, reporting a serum level as a blood level (serum level can be very much higher than the whole blood one) or someone used an alcohol wipe to draw the blood. Where we draw forensic tests we don't even HAVE alcohol products, just betadine.

The professional alcoholic (not your weekend binger, but the real pro) can tolerate much higher levels than you quoted. I personally have seen levels above .25 and up to .3 often. The highest I personally saw was .417. Do not assume that the levels were inaccurate.

 

[Jeremy89]

Check this one out!!

http://www.myfoxphoenix.com/myfox/p...ale=EN-US&layoutCode=TSTY&pageId=1.1.1&sflg=1

 

[reaper]

I had one last week with a BAC .572.

Pt was lying there with his eyes open, looking around, but no one was home. This guy did not react to any painful stimuli.

ED said he didn't start reacting till BAC was down to .415. By the time he hit .350, he was perfectly normal.