# 67 yo male with possible seizure and syncope



## HMartinho (Mar 21, 2017)

We receive a call to a 67 yo male with possible seizure and syncope.

When we arrive, we found a severe pale male, but with recovered mental status. GCS 15. Pupils equal and sluggish to light. His son, who is a nurse tell that his father had an absence seizure with some myoclonic moviments on his lips, followed by a syncope with a airway obstruction, wich reverse with jaw thrust maneuver, and recovers his consciousness. At this moment, patient states he feels sick, with severe náusea and diziness.

Medical history: Prostate cancer in 2013 treated with surgery. He did not take any medication.

Vital signs:

BP: 89/51 mmHg
Pulse: 62, weak but rythmic. Muffled heart tones but with no murmurs.
RR: 14 and regular. No SOB. Normal breath sounds in both lungs.
Pain: 6/10 on is forehead.
Temp (tympanic): 35,2 ºC
Blood glucose: 96 mg/dl
Pulse ox: 96%

We did not get any ECG because monitor malfunction.

So, we get an IV, and give 10 mg of metoclopramide, 1g of IV acetaminophen and a drip of normal saline.

Here is the ECG who ER nurse had done:
























Any thoughts?


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## StCEMT (Mar 21, 2017)

At least for me, you images aren't showing.


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## MMohler (Mar 21, 2017)

events leading up to?


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## E tank (Mar 21, 2017)

MMohler said:


> events leading up to?



Yeah, what was he doing before the event? Not near enough info, but from my experience, sounds like a vagal/cardiac event that caused cerebral hypoperfusion, syncope, AMS/seizure. Now resolved.


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## HMartinho (Mar 21, 2017)




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## HMartinho (Mar 21, 2017)




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## HMartinho (Mar 21, 2017)

E tank said:


> Yeah, what was he doing before the event? Not near enough info, but from my experience, sounds like a vagal/cardiac event that caused cerebral hypoperfusion, syncope, AMS/seizure. Now resolved.



He was watching tv. The patient did not remember anything else from "waking" laying on the floor.


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## BassoonEMT (Mar 22, 2017)

My differential would include what E tank said, as well as (less likely because of recovery) ca return and has metastasized. Tumors are always on my list for new seizures in the elderly. Always thought they would just be tonic/clonic until a convo with a nero doc. Said it's more rare but can be any type. 

Could have seen something on tv that triggered the vagal episode ;P


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## zzyzx (Apr 2, 2017)

Yikes, that's a long QT.


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## FLMedic311 (Apr 3, 2017)

zzyzx said:


> Yikes, that's a long QT.


joking..??


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## zzyzx (Apr 4, 2017)

Sorry, my bad. In the second photo the QT looks long, but looking at it more closely in the other photos it's less than about 400.


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## jaeems (Apr 11, 2017)

Is there any further history? Or is that all was provided?


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