Sunday, 24 October 2010

37 year old male CC: Unconscious

EMS is called to evaluate an unconscious 37 year old male.

En route to the scene dispatch advises paramedics that the  patient is now conscious and may have experienced a syncopal episode and seizure-like activity. The spouse believes that the patient may be having a stroke.

On arrival the patient is found lying in bed. He is alert and oriented to person, place and time, but not event.

He appears to be in excellent shape.

The spouse informs the EMS crew that the patient is an endurance athlete who has recently undergone chelation therapy to "clean out his system." It's clear this has been controversial topic their relationship. The spouse is not pleased about it.

She is clearly shaken by what has happened and is particularly concerned that the patient slurred his speech immediately after re-gaining consciousness.

The patient states that he was "worked up for chest pain" about 3 months ago and all tests came back negative. Otherwise he states that he has been healthy. He takes no meds.

Vital signs are assessed.

RR: 18
HR: 80 R
BP: 140/90
SpO2: 98 on RA

Breath sounds are clear bilaterally.

BGL: 108

The cardiac monitor is attached.

A 12-lead ECG is captured.

The paramedics sit the patient up to check orthostatics. The patient's eye contact becomes less focused and his speech becomes slurred. He seems weak.

What are your concerns?