# odd scenario?



## c-spine (Oct 4, 2006)

A paramedic friend of mine was telling me about a run he had been on the other morning. Said they were paged out for a 36 year old PNB female.

Got on scene, found a 33 year old PNB female, cool to the touch, with her jaw clenched shut. He said that the other medic tried everything to get an oral airway in - but her jaw was *really* clenched shut.

The alarm clock was still ringing when they got there.

There were pill bottles in her purse (her's and her husband's) and I think at least one was empty (but I don't remember what he said). 

So... what do you think it may be? This isn't one of those trick questions, I'm being serious..lol

A lot of the people he's talked to said it could be an overdose (the pills included Ativan). Someone else said heart attack. Someone said seizure followed by heart attack. He thinks it was either an aneurysm (brain) or prolonged QT syndrome (where if you get startled, you'll code). Reasoning for that was the alarm clock was going off. If it is prolonged QT, the alarm clock could have startled her enough to have her code. 

They did not, unfortunately, bring her back.


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## VinBin (Oct 4, 2006)

What kind of stuff did that medic try? Or was she called on scene?


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## c-spine (Oct 4, 2006)

I don't think the pt was called on scene - my medic said that they tried to get her mouth open, but couldn't. They thought to cric her, but decided on 2 nasal airways instead, which helped to get some O2 moving into her.


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## akflightmedic (Oct 5, 2006)

????

If the jaw was clenched shut and the pt was pulseless and apneic, this would be a non viable/non working patient. I am thinking rigor...

Now if the pt was clenched with a pulse and respirations, I would be thinking some sort of extrapyrimidial reaction, secondary to an OD, which would be cleared up with a little benadryl or the rare condition of Stiffmans Disease which is resolved with valium(however the whole body would be stiff/clenched not just the jaw).

What is PNB?? That is not a common abbreviation, more local term.
Is it pulse not breathing???

Are you sure she had a pulse being cool to touch and clenched jaw?

I am asking all these questions for my own information and to also make you review the scenario and ask yourself. SOmetimes kicking around questions and disecting calls will help you learn and realize something you did not before. I am not attacking or questioning the care provided by or the medics/emts themselves.

As to whatever else it could of been, I need a whole lot more info. What was on the monitor, what is pts history,etc...


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## Ridryder911 (Oct 5, 2006)

I agree AK, I need more info on H & P as well. The "clenched" jaw could be caused be from multiple things. 

From the initial findings of a 33 year old I would not naturally assume an AMI, (unless hx. of course would have to that rule out),  I would presume possibly post seizures from unknown etiology of possible cerebral bleed, seizure, and again who knows possible O.D. ?... 

I agree, I would like to know if she was cold and jaw clenched.. if this was not a viable patient.. 

I don't personally work anyone that is post arrest that is cool (non-environment induced) and definitely jaws clinched. 

The other probability of inner cranial bleed is high, as well as O.D., if she has other hx. of diabetes, obesity (P.E./F.E), recent illness, depression ?... 
I realize the "startled syndrome" is real, however; I believe to be very rare. Along with this "she was cool.. (therefore, downtime for a period of time) the alarm still ringing ( most alarms cease after a period of time) therefore the alarm would had ceased by the time they would had noticed her.

Needs to check for ME report... 

R/r 911


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## c-spine (Oct 5, 2006)

(It wasn't my pt..lol)


No, they were paged for a pulseless non-breathing (PNB) patient. Only her jaw was clenched, no rigor. She was cool to the touch, not cold yet (the medic told me that he figured she hadn't been down for more than an hour; but I don't know; could be less). Monitor = asystole. He said they started working her on scene. No dependant lividity either.

I was just curious to see what you guys thought it may be - he said he's going to see if can get the tox screen from a nurse cause he said he's baffled about the scenario. -shrug-


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## akflightmedic (Oct 6, 2006)

I dunno then, until more info is provided.

From what you have provided, I would never had worked it.

Asystole + clenched jaw +coolness(does not have to be cold) = no code


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## BrandoEMT (Oct 6, 2006)

I agree....I wouldn't have worked it either...


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## Ridryder911 (Oct 6, 2006)

Ditto.. anything documented or suspected over 10-15 minutes and is in aystole gets flagged. We don't work that has been down more than that...

R/r 911


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## Airwaygoddess (Oct 7, 2006)

*Very Odd call*

I hate to sound so morbid, but I wonder if she was a coroner's


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## Airwaygoddess (Oct 7, 2006)

*Really odd call*

I hate to sound so morbid, but I wonder if the patient became a coroner's case and an autopsy was done, sometimes thru the grapevine you can find out what was the cause of death?


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## MedicPrincess (Oct 7, 2006)

Ok, silly question maybe, but...what time did they arrive, and what time was the alarm set for?  This could rule out LQT as some alarms won't beep indefinantly.

One of the pill bottles was empty?  Should it have been?

And if they are working her, why wouldn't they cric her?  Seems a more secure airway than a couple of NC.

But I do agree with RR and AK.  We would have called DOA.


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## eggshen (Oct 8, 2006)

Cool to the touch? Rigored jaw? She's dead friend. The TMJ is the first place one get's rigor by the way, it's the first thing I check for.....saves a whole lot of work.

Egg


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## jeepmedic (Nov 21, 2006)

Any word on what caused this?


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## Fedmedic (Nov 22, 2006)

I agree, DRT-I'd be 10-8, available for call and kicked back on the couch with the remote.


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## trauma1534 (Nov 23, 2006)

I would not have worked this one at all!!!  DRT!!! FUBAR'ED!  EXPIRED!!  Nothing you can to for this chick!


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