captaindepth
Forum Lieutenant
- 151
- 60
- 28
Called to a crowded arena after a public speaking event for a 65y/o male with a "seizure."
When you arrive you find the patient sitting on the ground outside of the building against a wall in the shade. The patient is awake and alert and denies any current complaints (A&O x 4 with a GCS of 15). The patient is there with a social case worker who reported the patient had been standing in the crowded arena for approx 1 hour during the speech. Then upon exiting the arena the pt fell to the ground when he began to "shake." The case worker reported the patient then was able to get back up to his feet shortly after the initial fall and then after walking a few more feet fell and "shook" again. The case worker was unable to report the duration of the shaking but reported the patient had no period of confusion or AMS following the two events. The patient currently stated he "feels fine" and doesn't want to go the hospital.
The patient agreed to further evaluation in the ambulance (due to the crowded scene) and was able to stand and pivot onto the stretcher without assistance. The patient continued to deny any complaints throughout EMS patient contact. After further assessment the patient agreed to transport for further evaluation.
Physical exam findings include: airway patent, no signs of oral trauma/obstruction noted, able to speak in full sentences without difficulty, pupils PEARL (4mm), no head trauma found on exam. The pt had a normal work of breathing with no signs of respiratory distress, LS clear throughout all fields. No abdominal tenderness noted on exam (no urinary or bowel incontinence). No distal neuro deficits noted in the extremities, no trauma noted. Skin was extremely diaphoretic (needed a towel to wipe off the pts chest for 12 lead).
V/S: 96/50, HR 64, RR 20, BGL unremarkable (I don't recall the actual value but we can just call it 100mg/dL), SpO2 95% on room air.
Hx of HTN and Cirrhosis of the liver.
No drugs or alcohol reported or suspected.
Here are the 12 lead EKGs from the beginning and end of the call.
Would you be concerned for ACS? How would you treat the patient? Would you activate the cath lab?
When you arrive you find the patient sitting on the ground outside of the building against a wall in the shade. The patient is awake and alert and denies any current complaints (A&O x 4 with a GCS of 15). The patient is there with a social case worker who reported the patient had been standing in the crowded arena for approx 1 hour during the speech. Then upon exiting the arena the pt fell to the ground when he began to "shake." The case worker reported the patient then was able to get back up to his feet shortly after the initial fall and then after walking a few more feet fell and "shook" again. The case worker was unable to report the duration of the shaking but reported the patient had no period of confusion or AMS following the two events. The patient currently stated he "feels fine" and doesn't want to go the hospital.
The patient agreed to further evaluation in the ambulance (due to the crowded scene) and was able to stand and pivot onto the stretcher without assistance. The patient continued to deny any complaints throughout EMS patient contact. After further assessment the patient agreed to transport for further evaluation.
Physical exam findings include: airway patent, no signs of oral trauma/obstruction noted, able to speak in full sentences without difficulty, pupils PEARL (4mm), no head trauma found on exam. The pt had a normal work of breathing with no signs of respiratory distress, LS clear throughout all fields. No abdominal tenderness noted on exam (no urinary or bowel incontinence). No distal neuro deficits noted in the extremities, no trauma noted. Skin was extremely diaphoretic (needed a towel to wipe off the pts chest for 12 lead).
V/S: 96/50, HR 64, RR 20, BGL unremarkable (I don't recall the actual value but we can just call it 100mg/dL), SpO2 95% on room air.
Hx of HTN and Cirrhosis of the liver.
No drugs or alcohol reported or suspected.
Here are the 12 lead EKGs from the beginning and end of the call.
Would you be concerned for ACS? How would you treat the patient? Would you activate the cath lab?