# Assessing Seizure Patient w/no priors?



## highvelocity84 (Dec 22, 2008)

So I had a question on my final.  I have absolutely no clue why I got it wrong, except, I got it wrong! *laughs*

Here's the skinny on the question:

"38 y/o male has seizure @ work, no prior medical history.  Slow to respond to questions & complaining of a headache.  Which of the following info would be the most useful in determining how to treat this patient?"

The answer was "Checking the patients vital signs?"

Okay, I know vitals are important b/c they are done in every assessment...how can I understand why the VITALS are the MOST IMPORTANT in treating this patient?

Thanks for your insight!


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## Hastings (Dec 22, 2008)

highvelocity84 said:


> So I had a question on my final.  I have absolutely no clue why I got it wrong, except, I got it wrong! *laughs*
> 
> Here's the skinny on the question:
> 
> ...



I could understand that answer...if by vital signs, they include blood glucose.

Could be some sort of rogue, unwelcome gas in the area or extreme heat as well, but beyond that kind of stuff, you just get into brain tumors and head bleeds, and so on.

I don't know, sugar would be the top of my list, personally. Low sugar is a common cause of seizure in those without any history. Has happened to me a couple times before.


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## IcantThinkofAname (Dec 22, 2008)

Well the key to me is what is the most useful for TREATING the patient, not trying to figure out the underlying problem right away.  Vitals can tell you a lot...pupils equal/unequal, dilated, constricted, etc. - indicative of a head injury, stroke, drug overdose; BP and pulse - indicative of shock, etc.  You can treat for whatever results you find.

What were the other options?  I'm thinking if it's a patient with a seizure and no prior history who is unable to provide you with a lot of information, the best information you'll have is the signs you are able to obtain, rather than try to get any kind of SAMPLE or history of the present illness.


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## highvelocity84 (Dec 22, 2008)

IcantThinkofAname said:


> Well the key to me is what is the most useful for TREATING the patient, not trying to figure out the underlying problem right away.  Vitals can tell you a lot...pupils equal/unequal, dilated, constricted, etc. - indicative of a head injury, stroke, drug overdose; BP and pulse - indicative of shock, etc.  You can treat for whatever results you find.
> 
> What were the other options?  I'm thinking if it's a patient with a seizure and no prior history who is unable to provide you with a lot of information, the best information you'll have is the signs you are able to obtain, rather than try to get any kind of SAMPLE or history of the present illness.



The answers were:  Apply the AED (wrong!), determine if he's allergic to any meds, perform a detailed physical exam, and check patient's vitals.

Answer is the Vitals.

I guess you could see if they were in shock by their vitals to see if that was the cause??


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## FF894 (Dec 22, 2008)

What were the other options??


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## highvelocity84 (Dec 22, 2008)

*Misquoted answers...re-read*



FF894 said:


> What were the other options??



Sorry I misquoted:

The answers TO CHOOSE FROM were:  Apply the AED (wrong!), determine if he's allergic to any meds, perform a detailed physical exam, and check patient's vitals.

The Answer was CHECK PATIENT'S VITALS.


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## Hastings (Dec 22, 2008)

IcantThinkofAname said:


> Well the key to me is what is the most useful for TREATING the patient, not trying to figure out the underlying problem right away.  Vitals can tell you a lot...pupils equal/unequal, dilated, constricted, etc. - indicative of a head injury, stroke, drug overdose; BP and pulse - indicative of shock, etc.  You can treat for whatever results you find.
> 
> What were the other options?  I'm thinking if it's a patient with a seizure and no prior history who is unable to provide you with a lot of information, the best information you'll have is the signs you are able to obtain, rather than try to get any kind of SAMPLE or history of the present illness.



How do you appropriately treat a seizure patient without knowing the underlying cause?

Afterall, you're a Basic, and by the time you get there, they wont be seizing anymore. If you're not going to look for an underlying cause and treat that, then what are you going to do? Stand around and babysit the patient while you call for ALS?

At least take a sugar so they can get things going once they DO get there.


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## highvelocity84 (Dec 22, 2008)

Hastings said:


> How do you appropriately treat a seizure patient without knowing the underlying cause?
> 
> Afterall, you're a Basic, and by the time you get there, they wont be seizing anymore. If you're not going to look for an underlying cause and treat that, then what are you going to do? Stand around and babysit the patient while you call for ALS?
> 
> At least take a sugar so they can get things going once they DO get there.



Personally, I wouldn't be standing around.  But for this test, I only have one of those 4 options.

So choose out of those 4 options.  If its Vitals, which it should be, then why?


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## Epi-do (Dec 22, 2008)

highvelocity84 said:


> Here's the skinny on the question:
> 
> "38 y/o male has seizure @ work, no prior medical history.  Slow to respond to questions & complaining of a headache.  Which of the following info would be the most useful in determining how to treat this patient?"





highvelocity84 said:


> The answers were:  Apply the AED (wrong!), determine if he's allergic to any meds, perform a detailed physical exam, and check patient's vitals.
> 
> Answer is the Vitals.




As you have already said, applying the AED is obviously wrong.
Typically, you will get medication allergies during your SAMPLE history.  I usually don't get that first thing.  Instead, I will try to find out what events lead to someone calling 911.  After initially looking at my patient, and getting some basic information about the events, then I will start getting into my SAMPLE.  Therefore, not really the most important piece of the puzzle for this patient.
My initial exam is usually pretty quick.  I will check for ABCs and get baseline vitals.  This, combined with what I find out during my patient interview will determine what type of detailed physical exam I will conduct.  (Do I need to do a complete head-to-toe, or is their complaint a sprained ankle and I can focus in on just the injured area?)  Since I don't start out with a detailed exam, it may alter my course of treatment, but it isn't going to determine that course initially.
Checking the patient's vital signs includes things other than the obvious pulse, BP, and respiratory rate.  Skin condition, pupils, and orientation can also be included in that list, along with countless other things.  Furthermore, you can evaluate multiple vital signs at one time.  If you are talking to your patient while checking his/her pulse you are able to assess their orientation at the same time.  You are also able to assess skin condition while checking pulse.  You are using your assessment of baseline vital signs to assist you in forming a general impression.  You then use that general impression to determine a treatment path that you are going to go down.  Vital signs can tell you loads about a patient.  At the ALS level, the patient that is so tachycardic they are not adequately perfusing will get a different treatment than the patient that is bradycardic and not adequately perfusing.  They both most likely are in some sort of shock, and at first glance may look similar.  It isn't until you begin assessing vital signs that you are able to start sorting things out and form an opinion about what is going on.


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## highvelocity84 (Dec 22, 2008)

Then it appears I need to really sit down and find out why my vital signs are important! LOL.

I know why the vitals are important in your trauma, cardiac, diabetic, respiratory distress patients.

But then I've learned 'bout what the vitals and CSM look like for heat exhaustion/heat stroke....along w/hypothermic patients.

Drugs can certainly cause seizures & strokes...depending on if its an upper or downer, can sway vitals up or down.  Temperature could tell you if they have a fever, which is a sign of fighting off an infection...and at least in kids, the common cause for seizures is fever & headaches.  

But there was no mention of drug use in the question...

No prior history...means that psychiatric is ruled out.

No mention of trauma...that's rule out.

Guess that the vitals (preferably the CSM) can assist w/neurological functions, along w/perfusion & ABCs to make this the answer to the question be VITALS?


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## JPINFV (Dec 22, 2008)

highvelocity84 said:


> The answers were:  Apply the AED (wrong!), determine if he's allergic to any meds, perform a detailed physical exam, and check patient's vitals.



What's the one thing that will give you the most information about the patient's current status the quickest? Allergies? Important, but won't give you any information about the patient's current status.  Detailed physical exam? So checking the patient's legs for edema or palpating the abdomen for rigidity or masses (remember, it's a detailed physical) is going to shed light on the patient's immediate status? Err, not really. What's left?


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## Ridryder911 (Dec 22, 2008)

Their called *VITAL SIGNS *for a reason!  Geez.. this is a no brainer. 

Why place an AED? 

What is the first step in a detailed exam? = vital signs

R/r 911


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## highvelocity84 (Dec 22, 2008)

Ridryder911 said:


> Their called *VITAL SIGNS *for a reason!  Geez.. this is a no brainer.
> 
> Why place an AED?
> 
> ...



The answer I chose, was actually asking if they're allergic to any meds.

Please don't make me feel stupid.  I just completed my class and passed.  I'm on here for a reason...to become a very good EMT and hammer up the kinks in the system.

Appreciate the input, though.  Didn't know 'bout the edema.  Just remember how TINY the section is on seizures is in Brady's book.  Not big at all.


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## IcantThinkofAname (Dec 22, 2008)

My teachers have stressed that a lot of the NREMT questions have multiple "correct" answers, i.e. finding the BEST answer is the key.  So while asking about allergies isn't necessarily wrong, given the 4 options of AED, allergies, detailed physical exam, and vitals, you need to look at each and tell you which answer will give you the most information quickly.  So is checking vitals going to give you ALL the answers for treatment?  Nope, probably not in this situation.  But looking at the other options:  obviously AED is out, and a rapid exam would be more helpful than a detailed physical exam (what would you do a detailed physical exam of in this situation?), so now you have asking about allergies and taking vitals.  Of those 2, vitals are going to give you more information to work with than asking about allergies.  

Again, it's looking for the "best" answer, not necessarily one that is clear cut and the only "correct" one.


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## rhan101277 (Dec 22, 2008)

Ridryder911 said:


> Their called *VITAL SIGNS *for a reason!  Geez.. this is a no brainer.
> 
> Why place an AED?
> 
> ...



Yeah this is after ABC's, the once against after rapid assessment.  The doing it during ongoing assessment.  I need to get some experience to get it ground in.

Another thing that is done before you even get to ABC's is your general impression.  What you see on the way to the patient, a quick look at skin color, condition.  Level of consciousness is a big sign of how bad things are going.  But this stuff just takes seconds, guess you get so good at it, it just comes as second nature.


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## highvelocity84 (Dec 22, 2008)

IcantThinkofAname said:


> My teachers have stressed that a lot of the NREMT questions have multiple "correct" answers, i.e. finding the BEST answer is the key.  So while asking about allergies isn't necessarily wrong, given the 4 options of AED, allergies, detailed physical exam, and vitals, you need to look at each and tell you which answer will give you the most information quickly.  So is checking vitals going to give you ALL the answers for treatment?  Nope, probably not in this situation.  But looking at the other options:  obviously AED is out, and a rapid exam would be more helpful than a detailed physical exam (what would you do a detailed physical exam of in this situation?), so now you have asking about allergies and taking vitals.  Of those 2, vitals are going to give you more information to work with than asking about allergies.
> 
> Again, it's looking for the "best" answer, not necessarily one that is clear cut and the only "correct" one.



That's what I narrowed it down to on my test!  Just wanted to let you know.


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## traumateam1 (Dec 26, 2008)

Don't beat yourself up over this. A simple silly mistake.

If you really take a look at this, finding out if the pt is allergic to any meds would be a part of the Vitals, or Vitals/SAMPLE. When you have a medical emergency, it is generally 80% questions, and only 20% physical (including treatment). That being said, you need to figure out what is going on, and why. By asking the patient the basics (aka SAMPLE) and obtaining a set of Vital signs, you will find out a lot about this patient.

This first thing I do, when I walk into a room or area of a "first time" seizure pt is find out if there is a need for C-Spine. After that, I would go do my ABC's and RBS. The RBS is to find out of any injuries, but also to find a medical alert bracelet or something that may help up out here. After that I would start on my vitals.

*Based on the choices you were given* taking vitals would be the first think I would do.

Again, simple silly mistake. Don't beat yourself up over this.


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## Melbourne MICA (Dec 30, 2008)

*First things first*

Many exam questions are about orderly thinking process not diagnostic skill. In other words does the student understand the importance of his approach to an incident and the need to apply a consistent step by step approach?

They offered you options for your first step in the exam of the patient. If you asked the guy about allergies and he was too confused to answer where would that leave you? Nowhere. The same goes for the AED - the machine say "no shock advised" - not much help there. And the secondary survey is where in the process?

If the pt is not in a life threatenting situation then the vitals will help answer the next important question, is the pt sick? And the great thing about vitals is they are signs - ie the pt doesn't have to tell you them. That comes in pretty handy when the pt is unconscious wouldn't you say?

Nobody expects diagnosis of hypo/subArach/etc. Start with the numbers, then ask the questions, then put it all together to establish a treatment plan. Then revise, reassess look for trends etc etc.

When you treat the options you choose will be based around these early and important numbers. If these numbers start to change your treatment may well change as well. But you won't know if you haven't got a starting point.

First things first. 

MM

MM


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## BossyCow (Dec 30, 2008)

Also, since it was stated that the pt has no previous medical history, what meds is he taking? Probably none. Meds are a treatment for a medical condition. Vitals are going to give you the most information in the shortest amount of time. Also.. look at the whole picture.. the pt is no longer actively seizing.. Obviously AED is out..the detailed physical exam is never a option for a first treatment.. ever.. rapid physical exam.. size up.. initial assessment are always going to happen before your detailed physical exam.


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## Veneficus (Dec 30, 2008)

From the test taking skill perspective:

A: apply the AED, a brainless distractor. he is not unresponsive, pulseless, so no shock advised. It does nothing for you.

B: med allergies. Why? Seizure is not a symptom of an allergic reaction. (just to be sure, I consulted Harrison's Internal Medicine 17th edition to confirm this statement page 2063) so again a pointless distractor.

C: detailed physical exam. considering the common causes of seizure, unless you can examine his brain, it is unlikely to yeild any information. also considering it is a male that rules out eclampsia. 

D: vital signs (by process of elimination, this is the BEST answer) though I think not exactly screaming "pick me! pick me!"

Also pick up on the phrase: "most useful in determining" something that would help you make a decision. an AED will not, med allergies might, but I agree with poster who said no hx could be assumed no meds, detailed physical is not likely to provide seizure information, so your best diagnostic tool at this point is vitals.


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## mycrofft (Jan 1, 2009)

*Veneficus would you come talk to my coworkers?*

They get all excited and have to "do something". They are non-street experienced nurses.


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