Late one evening, Ambulance 463 was dispatched for a 24-year-old patient with a reported change in responsiveness. While en route to the scene, dispatch advised 463 to “step it up” because the family had called back and reported the patient’s condition had worsened.
On EMS arrival, the patient was found to be semi-conscious and lying sprawled across a chair in the living room. The patient’s wife said the patient had been playing a video game while sitting only three feet away from the TV. The patient began “acting like he was waving at a fly” and then fell to the floor and began to exhibit tonic-clonic activity. His convulsions lasted only a couple of minutes and were generalized in nature. He had also vomited several times prior to EMS arrival.
The crew found the patient confused and postictal when they began their assessment. In fact, he attempted to get out of his chair and walk around the living room in a dazed state of mind. His initial blood glucose level was found to be 118 mg/dL, BP 150/100, pulse rate 120 and GCS 13. He was helped to a stretcher, but he vomited several more times before he could be secured.
A detailed exam found that his pupils were dilated and slow to react. He had bitten the right side of his tongue during the seizure with no active bleeding noted. He also had a small abrasion to his forehead secondary to the fall from his chair. No other visible trauma was noted.
His chest was clear bilaterally to auscultation with equal rise and fall, and good respiratory effort was noted. The abdomen was soft, non-tender and non-distended, although the patient was obviously nauseated. He was neurologically intact with good movement of all extremities, no facial drooping and no unsteady gait noted.
En route to the emergency department (ED), the patient’s ECG revealed sinus tachycardia at a rate of 120. Oxygen was initiated via nasal cannula at 4 lpm.
After initial treatment, the patient became more alert and oriented to his surroundings. Vomiting or obvious seizure activity ceased. On arrival at the hospital, the patient was able to give his date of birth, address and complete medical history.
The patient’s hospital evaluation included lab work and a head CT, both of which were normal. He was discharged with seizure precautions and driving restrictions, and given a referral for neurologic follow-up. However, he was brought back to the ED just one week later by another EMS agency after attending a child’s birthday party at a local entertainment complex, during which he was around a fire truck ride that featured multiple flashing lights.
During the second incident, the patient experienced migratory numbness from one side of his body to the other and felt like he was going to have another seizure, although he didn’t. During his second ED evaluation, his lab results were again normal, and he was placed on anti-seizure medication after consultation with a neurologist. The patient was to follow up for an MRI of his head and further consultation with the referral neurologist.
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