This interesting case is thanks to Dana from Redmond Medic One, we hope you enjoy it as much as we did!
You're dispatched with a nearby engine company to an assisted living facility for a 90 year old female who has had a seizure. Dispatch notes indicate the patient is alert at this time.
You're by the officer off the engine outside, who leads you in to the dining area. You see an awake elderly female, seated in a chair, being assessed by the engine company. Her husband states she had a seizure which, "lasted maybe 10-15 seconds, her arms and legs were jerking the entire time."
While your partner gets a report from the firefighters, you introduce yourself and ask the patient how she feels.
"Well, I felt ok earlier. Never had this happen before."
- PMHx: COPD, diabetes, "heart attack", CABG, dementia, "mass in my lung"
- Allergies: NKDA
- Medications: Coumadin, "nebulizer"
- Last ins/outs: was eating dinner when this happened
- Events: sudden onset, tonic/clonic activity, no apparent post-ictal period
Your partner relays the initial vitals:
- Skin: pale, cold, dry
- Pulse: 123, irregular
- BP: 94/64
- Resps: 24, unlabored
- SaO2: 96% on 3 L/min via NC
- BGL: 188 mg/dL (10.4 mmol/L)
- Temp: 99.7° F tympanic
As the monitor is turned on it begins chiming. Electrodes are quickly added for a 12-Lead.
When asked about the rapid heart rate, her husband states, "she's had a fast heart before when she takes her nebs, but never this fast."
One of the firefighters obtains a repeat set of vitals:
- Pulse: 200, weak radials
- BP: 92/68
- Resps: 16
- SaO2: 98% on 3 L/min via NC
You're less than 10 minutes from 2 hospitals, including a PCI capable facility.
Your patient states dryly, "I feel pretty tired."
What is your interpretation of the rhythm and do you agree with the monitor's interpretation?
Is this a load and go situation?
What do you do next?