63 y/o ams

[mycrofft]

I wasn't kidding by the way about language, teeth, and herbals.

An edentate sixty-plus year old woman high on ephedra tea and speaking Hmong could be interpreted as crazed (or even extraterrestrial) when all ahe is saying is she left her teeth in the bathroom and could we bring her tea along please?.

 

[knxemt1983]

130/88 to 108/60 in how long?

skin signs?
mental status?

in about 20 min. from scene time until destination. mental status never changed from the mumbling, never responded, even to painful stimuli

 

[knxemt1983]

I'm going to go out on a limb here and say stroke, or possibly a severe untreated UTI. We recently had a patient present with pretty similar findings that was in fact a stroke. Now without knowing her mental status, I cannot say for sure, but her BGL being within normal range and the uncontrollable (I'm assuming) movement of the arms in air (which our patient was doing as well) leads me to think stroke

no abnormal findings on ct

 

[knxemt1983]

Ideopathic psychosis with altered mentation secondary to Neurontin......................

Neurontin, for some unknown reason, has shown to cause some memory loss along with altered mentation. It could also be anxiety secondary to postherpatic neuralgia, along with an underlying unknown cardiac issue, which could be causing the tachycardia associated with the monitor's findings.

However, if the pt. was truly in a salvo or VT rhythm, then the pulse is not 102 or 110. Regardless of being symptomatic or not, VT that last 15-20 seconds is never stable and needs to be treated. An anti-dysrrhythmic would have been appropriate in this case.

I too would love to see the Chemistry results.

Interesting case!

not neurontin complications
I thought about anti-dysrythmics and we have protocols to treat cases like this, but by the time it progressed to more than an occasional pvc we were less than a minute from the ed doors, so I opted to go on into the ER, it would have taken longer to get out the amio, then mix it in a half NS bag per protocol etc etc etc

 

[knxemt1983]

How long had she been taking the med? As for the drop in BP she was active in the house was she that way in the back of the truck of did she calm down some? That could explain the drop.:huh:

you could be onto something here, but I'm not totally sure. the activity did stop once we got her onto the cot.

 

[knxemt1983]

An edentate sixty-plus year old woman high on ephedra tea and speaking Hmong could be interpreted as crazed (or even extraterrestrial) when all ahe is saying is she left her teeth in the bathroom and could we bring her tea along please?.

afraid thats not it either

 

[knxemt1983]

the Dx from the hospital

ok heres the details

respond code three to the subsidized housing district. upon arival fire is standing with the patient in the bathrom. she is mumbling unintelligable words, and very sweaty, swingin her arms up in the air like shes a bird.

only Hx is of current case a shingle being treated by only meds of neurontin, and valtrex.

63 y/o
v/s 138'88
pulse 102
rr 20
sp02 95%
BGL 117
pupils PEARL
monitor shows NSR borderline ST
no trauma
anything else you want let me know and I'll get it


she got the usual, 02, iv tko, monitor


on the way into the hospital she she strated with bigeminy pvc's, then bigemy couplets, then would have runs a vt with a pulse lasting ~15-20 seconds, then back to nsr. we were <a minute out so I didn't get to treat, and honestly don't know if I would have since I had ni idea what was going on.
So what would you all have done, and what Dx can you come up with

all I could do was the usual o2 iv monitor until she developed the runs of VT.
by the time she developed VT we were almost to the er, and because I had no idea what was going on I opted to go on into the er instead of taking the time sitting in the er bay to hang amio or lido.

once inside the er, gave usual report and left to do paperwork. I went back in to drop a copy of the run ticket off for the er staff and got questioned by the doc on what was going on, what the scene looked like, how the apartment was kept etc because he too was strugling with it.

I went back and checked on her after my shift was over, and it turned out she was suffering from..... acute COCAINE overdose..... they pushed 0.4mg of narcan, and she came around a little, by that time they had already RSI's her so she was tubed and went on up to ICU

I missed checking pupils, and she had no resp compromise, or I might have had an idea, but still 63 y/o that really caught me off guard. well I guess you live and you learn

 

[mycrofft]

OOPS, Litella maneuver, code 4

Thanks!