Unresponsive

Yes they are. And that looks like some kind of block. It is difficult to tell on such a short strip, but it looks like there is a pattern to the irregularity.
 
abckidsmom said:
Those are some peaked T waves, huh?
?
Click to expand...

Simple....poor lady thought so too...said "egads! A bizarre rythm with peaky t waves...must be hyper-K!" and gave herself some insulin to flatten em down a bit...just forgot the D50.


sidenote: how many here have given D50 through an IO? The one time I saw it attempted it took an awful lot of pushing to get it in (IO flushed fine with NS). Does it need to be diluted down a bit to get it to flow?
 
I'm going to go ahead and venture a guess that this can be summarized with "metabolic disarray."
 
jrm818 said:
Simple....poor lady thought so too...said "egads! A bizarre rythm with peaky t waves...must be hyper-K!" and gave herself some insulin to flatten em down a bit...just forgot the D50.


sidenote: how many here have given D50 through an IO? The one time I saw it attempted it took an awful lot of pushing to get it in (IO flushed fine with NS). Does it need to be diluted down a bit to get it to flow?
Click to expand...

I've given it through an IO just once. I pushed it straight and slow. It was no big deal, except that the lady woke up and I felt like an evil sadistic person. More lidocaine next time.
 
Huh, that's what I expected for the IO issue, I've heard elsewhere that it works OK. I wonder what the issue was when I saw it done.

At any rate, "metabolic disarray" sounds about right.

Agree with checking for pill bottles around. Assuming no drugs/etoh, maybe some unfortunate adrenal problem/Addisons type deal (BP notwithstanding). or an insulin secreting tumor. Or hypopituitaryism.

Dunno what you're going to do about any of that in the field. Symptomatic Rx at this point sounds about right to me.
 
jrm818 said:
Huh, that's what I expected for the IO issue, I've heard elsewhere that it works OK. I wonder what the issue was when I saw it done.
Click to expand...

You have to energetically flush it when you first establish the line to clear out the inter medullary space. If you don't give it a vigorous flush, it won't run well.
 
Okay... Sorry. Just went on a call.

Here's some answers.

As stated above. Cool, dry and ashen.
No pill bottles or alcohol to be found.

Glucagon did nothing. She got drilled, and an amp of D50. Sugar went from 19 to 15. Per med control, she also got 2mg of Narcan. Which also did nothing (as you'd guess)

Vitals all stayed the same. (No changes of note)
 
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abckidsmom said:
Sugar went from 19 to 15?
Click to expand...

Yep. 19 after the glucagon ... 15 following an amp of d50.

This was not my call, BTW. I just reviewed the chart and talked with the crew that ran it.
 
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Next pressure was 132/64. HR 78 irreg.
respirs 22 and shallow.
 
Well bugger.

Assuming your glucometer is working properly, I'm still not convinced that this wasn't an ingestion of some sort. ASA? Wouldn't' necessarily notice that pill bottle.

How bout empty bottles of antifreeze in the garage? I can't find a reference to toxic alcohols causing hypoglycemia, but alcohol can it so perhaps?

Or unfortunate metabolic derangement/tumor. Would need a better history to really clue in to that though.

That EKG just looks...well...bizarre. Hyper K is still my bet. I don't know what to call the rhythm...if I use my imagination I can see p waves in some places, but not regularly, and certainly not in front of the QRS very often.
 
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Ok, so here's where we are.

Arrive at the ED and the pt has had glucagon, dextrose and Narcan. No response.

Shortly after arrival she was intubated, placed on a vent and moved to ICU. ED doc says hyperK, but is not convinced. In checking with the ICU charge for follow up and will get you guys the full details as soon as I know.
 
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I was going to add that I might be tempted to try to treat her for her "shoot I lost the rest of my prednisone" induced Addisonian crisis, if I had no more answers and this long to think about it.

wonder how acidotic/metabolically screwed up she was.

interesting case - look forward to getting an answer.
 
For what it's worth: the pt had no history of anything. The ex husband is a nurse and found her unconscious. There were no drugs, rx meds, alcohol or anything untoward in the house. Pt was last seen normal this morning.
 
gaahh! this is going to bug me too now....

back to insulin secreting tumor or adrenal dysfunction of her bodies own making
 
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