Thoughts?

[MedicPrincess]

11 y/o non-menstrating Female, history of Aspergers. Current meds Adderall 30mg and Prozac. Tends to run Tachy at about 120 regularly. While sitting in band listening to lecture, she expierences a loss of consciousness, falling from a sitting position to the floor. School nurse summoned, finds same. After obtaining parental permission, EMS is called.

Vitals all WNL except heartrate of 131. BP 105/71, O2 100%, Resp 20, pt is still unresponsive. Raise the arm, drop it, and it smacks her in the face. Ammonia capsules under nose, no response. Sternal rub receives no response. 20 gauge in the L arm, and no response to the stick. Pt is placed on 15L NRB per local protocols for unconscious patient. Narcan given, also per protocol.

Parents request a specific hospital, even though it isn't the closest and is actually 30 minutes by ground vs. the 5 minutes the other one is. EMS honors the parents wishes. Lights and Sirens to the ER. Pt remains unresponsive enroute.

Transfer to ER. Pt gets another 18 gauge in the Right arm, no response. One extra sternal rub from the medic, nothing. After being stripped from the waist down, patient has bottoms of feet scratched, rectal temp and is straight cathed for urine with no response. Pt remains unresponsive. Blood drawn, chest Xray, and CT scan. Pt remains unresponsive throughtout each procedure.

All labs, XRay, CT come back normal. Vitals remain normal throughout with the exception of her pulse, it remains in the 100-130 range.

After 3 hours, she begins to become responsive. After another hour she is discharged home. ER doc says he doesn't know, he calls it "Syncope with unknown Physiological Reason." She is my daughter. Opinions? And don't be afraid your going to hurt my feelings.

 

[medic03]

hmm, interesting.... anything like this before? Would you say she was in a catatonic-like state or more along the lines of an unresponsive/unconsious pt. Any SZ HX with a long postictal phase? Whatever is it, I hope you are able to get it figured out and not have it happen again. I would send her to a a few more Doctors to be cleared

 

[MedicPrincess]

Unresponsive/Unconscious.

Forgot to include... Pupils were Equal, Mid-Point, Non-Reactive. DR did that gross touch them with a Q-Tip, with no response.

nothing like this before. She had been complaining of nausea/headache/general weakness X 3weeks. No SZ HX in her or our family.

 

[Wingnut]

Wow Princess, sorry no thoughts other than get her to a specialist, maybe try Gainsville Univeristy? They're supposed to be one of the best. I really hope you find out what's going on, I can imagine how you feel as a mom. I'm here for ya sweety.

 

[rescuecpt]

First, why did the school call for permission to get EMS first, when they had an unconscious 11 year old???

Second, did they do a sonogram of her heart and lungs? Maybe she had a clot in one of those places?

I'm going to have my fiance (hehe, also known as MY MEDIC) read this and give his opinion, he's good at this.

 

[TTLWHKR]

Thoughts?

Call 911. :unsure: IDK.

Google it.

 

[MedicPrincess]

Originally posted by rescuecpt@Nov 24 2005, 12:20 PM
First, why did the school call for permission to get EMS first, when they had an unconscious 11 year old???

I called back to specifically ask that question after we got home. Its School District Policy. As long as the child is breathing they will get parental permission before calling an ambulance. Reason for this...You guess it, Liability. If they call an ambulance without permission, then the school can be held liable for the bill.

No sonogram of anything. Just a CT of her head. We were able to get referrals to Pedi Cardiology and Pedi Neurology though.

Tried google. Didn't find much except call 911.

 

[Chimpie]

Sorry to hear about this Princess and I hope she gets better soon.

Maybe you should write the writers of House, MD and have them do a show about it. :blink:

 

[rescuecpt]

Ok, my medic came back with some questions:

Was there any recent head trauma?

Does she play sports?

Have there been any recent family or personal problems, mood swings, etc?

Why is she taking prozac, has she been taking it as prescribed, how long has she been on it, are any of the meds new, have there been any noticeable side effects?

Does she have a boyfriend, if so, are things going well with him? Is she sexually active? Is there any possibility of abuse (sexual, mental, or physical)?

Was there any indication of seizure (ie, activity)?

Why is she taking the Adderall? is it for ADHD or something else? Is the prozac meant to counteract the effect of the Adderall?


- I know these are pretty personal questions - if you want to PM the answers to me, or not answer at all, I'll understand.

 

[MedicPrincess]

I am okay with questions. I expected them, afterall I came looking for ideas.


Does she play sports? Basketball (not in season), Bowling

Have there been any recent family or personal problems, mood swings, etc? She's in the 6th grade and trying to enter puberty. She has mood swings, but none that were new

Why is she taking prozac, has she been taking it as prescribed, how long has she been on it, are any of the meds new, have there been any noticeable side effects?
Prozac for Anxiety secondary to the Aspergers.

Does she have a boyfriend, if so, are things going well with him? Is she sexually active? Is there any possibility of abuse (sexual, mental, or physical)?
No boyfriend. She would be the next Pope if girls were allowed.

Was there any indication of seizure (ie, activity)?
No traditional seizure activity reported. She states she was sitting in her chair, started to feel funny, her vision went blurry, and she woke up in the ER.

Why is she taking the Adderall? is it for ADHD or something else? Is the prozac meant to counteract the effect of the Adderall?
Adderall for the Aspergers. She was on Strattera, however her heartrate was sustained above 140, so she was put on Adderall. She still sustains around 120.

 

[TTLWHKR]

Originally posted by EMTPrincess@Nov 25 2005, 01:02 AM
Was there any indication of seizure (ie, activity)?
No traditional seizure activity reported. She states she was sitting in her chair, started to feel funny, her vision went blurry, and she woke up in the ER.

That was my first guess, seizure activity.

Any thoughts on Cardiac Syncope? Sudden or odd movement of the body can cause a vasomotor reaction, leading to a ventricular standstill, dizziness, drop in bp, and sudden syncopy... I believe it may also be called cartoid sinus syncopy, the constriction of a artery that feeds the vasomotor region. Probably get a better answer from someone who knows about that stuff.

I read about that once after a fainting spell involving the pinching of my index finger. That was a Vasovagal Syncopy, I went completely numb, couldn't breathe/speak/feel, collapsed to me knees and blacked out. Then I was fine, and my finger never did hurt. :blink: Wierd huh?

 

[Wingnut]

Originally posted by TTLWHKR@Nov 25 2005, 06:10 PM
:blink: Wierd huh?

yes :blink:

 

[Margaritaville]

Princess,

I saw something like this about 8 years ago in a child with Down Syndrome. It was found out that he had an Ammonia imbalance. I know it sounds weird, but it was picked up in his labs, and I transported him twice. Its a stretch, but it can't hurt to check.

Also, I know you are down south, but go on Kennedy Kreiger Institute at Johns Hopkins Hospital online. They are the number one hospital in the United States for the treatment of Autism. I am very lucky that we only live a few hours from there.

The staff would be glad to talk to you about your experience, and may have seen this before. Like I said, they are #1. They have also more access to research than you could imagine.

If you need any other information - Please pm me. I will give the info I know.

I have found out that with Autism - expect the unexpected. Its always an adventure!!!

Good Luck

 

[MMiz]

I dont have the slightest clue as to how this would work out, but how is she doing now?

 

[Jon]

no clue, but I'm with the Captain on this - first, an unconscious kid = 911 NOW. Perfect example of implied consent. Also - this should have gone to the closest ED, espicially with the timke difference. If the patient needed to be admitted, the Pt. could probably be transferred, but needs a CT scan and labwork started ASAP.

Jon

PS - I assume the extra distance was to the ED you work at - still, I would have had a big problem with this being my patient...

Jon

 

[Stevo]

"Syncope with unknown Physiological Reason."

yeah we've ahd a few of these. unfortunately they tend to endure a barrage of testing with little validation towards any one malady, and are eventually told they 'outgrew it'

may your little one fare better than they Princess....

~S~

 

[Luno]

I'd hypothesise (sp?) with Stevo, when you first posed this, I wracked my brain, that that's all I could think of, with vitals WNL, I couldn't think of anything else.

 

[MedicPrincess]

We had another episode a couple days ago. Her reg Dr is thinking of Prolonged QT syndrome. Her 12-leads from both ER visits show a definant prolongation.

Didn't say much about it, other than she'll definantly need to see cardiology and neurology (to r/o neuro causes).

 

[Wingnut]

Princess, I can only imagine how hard this is for you to go through. My thoughts and prayers are with you and your daughter.

Keep us updated, let us know what Cardiology thinks.

 

[Jon]

Originally posted by EMTPrincess@Dec 7 2005, 01:58 PM
We had another episode a couple days ago. Her reg Dr is thinking of Prolonged QT syndrome. Her 12-leads from both ER visits show a definant prolongation.

Didn't say much about it, other than she'll definantly need to see cardiology and neurology (to r/o neuro causes).

Has she worn a holter monitor for a day yet?

If this keeps on happening, having a holter on her when it does would be nice for the docs.

Jon