Throughout this blog, I will make reference to cases that I have had in the field or in the hospital. For obvious reasons, all identifying information has been removed in order to comply with HIPAA.
The other night, we were dispatched to a possible stroke. When the engine company arrived on scene, they performed a stroke scale and found the patient to have slurred speech and a sluggish right pupil. The patient was also hypertensive and repeatedly pointed to her head. Pt. vitals were as follows 168/92, P 118 Sinus Tach, R 24, LS clear. 12-lead normal. Pt. was moving her mouth in a repeated manner that had the appearance of "guppy breathing" Pt. has extensive psych history and multiple medications that include Geodon and Ritalin. What would your differential be? We did not transport to the stroke center since the pt. had an inconclusive stroke scale and was know to have a similar episode last week.
Upon arrival in the ER, the physician having seen her before, took one look and knew what was the issue and gave her Diphenhydramine IV. Have you figured it out yet?
The pt. was experiencing side effects from overdosing on her Geodon. The slurred speech, warm and flushed skin, sluggish pupil, and "guppy breathing" were all a result of too much Geodon. The treatment for Geodon OD is 50mg of Diphenhydramine IVP. As soon as this medication was given her symptoms began to clear up. The "guppy" breathing action is called Tardive Dyskinesia ans is a preexisting condition that is exacerbated by Geodon OD. As you can see, the patient may not always fit you differential in the end, thus your patient may not always have the horses their hoofbeats lead you to suspect.
No comments:
Post a Comment