Critial Neuro Patient Curiosity
Hey all,
I'm an EMT, and today I had a chaotic call involving what I believe to be a neuro TBI patient, and I would like some input on what I was looking at.
Got called for a stroke, patient was slumped over in her wheelchair, AOx3, GCS 15 but slow to respond, abnormal from baseline. Negative Stroke scale, no ataxia, slurred speech, equal strength and sensation bilaterally.
Pts husband says she had a fall yesterday with a head injury but didnt seek medical attention. Negative LOC and Negative anticoaglants.
On scene, our patient within seconds went apneic/agonal breathing with no gag reflex, and profoundly hypotensive (50/26). NSR on cardiac monitor but eventually went to bradycardia at a rate of like 25-30BPM. My Paramedic partner gave 100mcg Push dose epi and raised the BP to 75/40, but pt has an intermittent gag reflex, comes and goes, so we stuck to BVM ventilations.
On arrival to the ED, pt immediately Asystolic with no cardiac down trend. NSR now at 60ish to asystole in 2 seconds flat. Medic partner shared concerns that it may be late stage herniation, but they just did a thoracotomy, noticed cardiac standstill, and pronounced TOD.
Obviously extremely chaotic, and I very well could be hyperfixating on herniation when it could be anything. Just figured I'd see if anyone has input, clinical suggestions, or any other comments to wrap my mind around what happened.