A 70s F with a hx of htn, CLL, esrd (on hemodialysis) presents with cough and myalgias. Her VS are HR 78, RR 18, BP 168/77, T 101.4, with a RA sat of 98%. Her sepsis work-up shows a small LLL infiltrate. The WBC is 5.6 and the lactate is 0.7 (normal 0.3-1.3).
How do we treat and dispo this patient?
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When a patient has a seizure, check a pulse.
It doesn’t happen often, but seizures may be cardiac in cause. The patient has an arrhythmia, loses perfusion to the brain, and the brain seizes.
The most common arrhythmia in my experience is vfib. When the patient is on a monitor, you can see the patient go into vfib, then 10-20 seconds later, they will have a generalized tonic-clonic seizure that lasts 20-30 seconds, then become unresponsive (and dead). Checking a pulse will save you from a few minutes of panic and defibrillation time, as some residents found out this year.