the case.
a 28 year old male presents to your Emergency Department with a 2-3 week history of increasing neck swelling. He is now spitting out frank purulent discharge from his mouth and reports fevers and night sweats.
pulling apart cases from the ED...
the case.
a 28 year old male presents to your Emergency Department with a 2-3 week history of increasing neck swelling. He is now spitting out frank purulent discharge from his mouth and reports fevers and night sweats.
The Case.
The ‘Batphone’ alerted us of a 68 year old female who is postictal following two seizures in rapid succession. She has a history of ‘a brain tumour’.
P 120. BP 176 systolic !! GCS 8/15. Afebrile. Sats 98% (15L NRB + guedel airway).
She arrives direct to your resus bay 4-5 minutes later and she is actively seizing.
A) Obstructed (Guedel on floor). Trismus ++.
B) Bilateral air entry. Sats 99% on O2. No added sounds.
C) P 130 (sinus) BP 185 systolic. Diaphoretic. Warm peripheries.
D) Actively seizing (GTCS with movement in all 4 limbs). Pupils 4mm (L+R).
E) Temp 37*C. BSL 13. No rashes, contusions etc.
Impression:
Status Epilepticus (3x seizures with no return to normal mental state)
Following resolution of her seizure she remains obtunded, GCS (E1V1M4) 6/15 and still obstructing her airway. A decision is made to RSI for airway control and prevention of secondary brain injury, followed by urgent CT. [Read more…]