Got called for a seizure-but it wasn't.

Sinus arrythmia with unifocal PVCs... probably due to hypoxia.

I'd say seizure and there's a zillion reasons why you could have one of them. It explains the initially low SpO2, the hypertension, ALOC and it can explain the pupils. The ectopy on the ECG could then be from hypoxia.

Not too sure about the vomiting / blood stuff. Trauma from the airway has already been said and I'd agree with that.

What makes you say it wasn't a seizure?
 
DPM said:
Sinus arrythmia with unifocal PVCs...
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That's my guess for the strip you showed us.

Hard to guess about the tinged vomit since I'm guessing you didn't have time to take a picture of it to show us here on this forum :) haha. NPA or OPA seems very likely but who know she could have been eating strawberries before bed.

Good call thanks for sharing!
 
Just wanted to add something about the pink froth. Are you sure it was vomit? It doesn't take a lot of anything for it to go "all over the place"... It might sound silly, but did it smell like barf? And you say 'pink tinged', so was it clear with a pink tinge? Oral trauma from OPAs is pretty common, and it wont take a lot of blood / spit to make a mess like that.

Either way, with 20:20 hindsight we haven't been able to really nail this one down, but from where I'm sitting it looks like you did everything you could. You got a fairly decent grip on the ABCs and did your best with what sounds like a tricky airway. Even with the OPA getting spit out, you got the SpO2 up from a nasty 74% up to a much better 85% in pretty short order. As for not getting the IV, it doesn't sound like you really needed one. I think you made the call getting her to Hospital instead of d*cking around for an IV that you most likely wouldn't be using yourself.

Well done, and thanks for sharing. I love these.
 
I would say a brain bleed. The AMS, posturing, and vomiting would suggest this. The EKG is merely a result of the hypoxia. I would agree that your load-n-go was the way to go.
 
med51fl said:
I would say a brain bleed. The AMS, posturing, and vomiting would suggest this. The EKG is merely a result of the hypoxia. I would agree that your load-n-go was the way to go.
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Do you see Cushing's triad? The pulse pressure isn't that wide and there's tachycardia, not bradycardia.
 
True that all three components of Cushing's Triad (irregular respirations, widening pulse pressure, and bradycardia) are not present. The only part presented in this case is the irregular respirations. The widening pulse pressure cannot be determined since there is only one blood pressure to go by. The only thing I would caution is that the full-blown "classic Cushing's Triad" is often seen late in significant bleeds. More often early on in brain bleeds you will see vomiting, irregular respirations coupled with altered mental status. The posturing could be as a result of a bleed or just a side effect of the hypoxia.

With that being said, there are several other possible conditions that could manifest with the original presentation such as first time seizures, over dose, undiagnosed brain tumor, etc.

The end result was the airway was managed as best they could and rapid transport to definitive care was provided. The reality is this is our primary function (correct / stabilize the life threatening and rapid transport to definitive care).
 
med51fl said:
True that all three components of Cushing's Triad (irregular respirations, widening pulse pressure, and bradycardia) are not present. The only part presented in this case is the irregular respirations. The widening pulse pressure cannot be determined since there is only one blood pressure to go by. The only thing I would caution is that the full-blown "classic Cushing's Triad" is often seen late in significant bleeds. More often early on in brain bleeds you will see vomiting, irregular respirations coupled with altered mental status. The posturing could be as a result of a bleed or just a side effect of the hypoxia.

With that being said, there are several other possible conditions that could manifest with the original presentation such as first time seizures, over dose, undiagnosed brain tumor, etc.

The end result was the airway was managed as best they could and rapid transport to definitive care was provided. The reality is this is our primary function (correct / stabilize the life threatening and rapid transport to definitive care).
Click to expand...

The bolded area is the most important (of course) and I have no arguments there. My thinking was that if there was a bleed on the brain, and it was significant enough to cause posturing, then the bradycardia would have already kicked in. Likewise, I didn't think cerebral hypertension / Increased ICP was transitory, so why would the posturing come and go? And was it actual posturing, or was it the PT starting to move about now that she's postictal...
 
UPDATE


She died the next day.


From what I was told due to strong religious beliefs, family refused to have a full autopsy. So the only thing was done was the exam they do to rule out obvious homicide.

She ended up having some sort of bleed though and that is what seemed to cause it.
 
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