The last time we spoke, my shift was having an "interesting" evening. There were many "WTF?" moments, but I think we all handled it rather well. Every patient was well cared for, and arrived safely at the hospital. One of my patients was admitted to the ICU at our local hospital, where my wife works. I like it when that happens, because I can get a better followup than most EMS agencies get regarding a patient they've transported. Most of the time, that followup just confirms what I thought already, and lets me know how the patient is doing. Generally, that's all I really want to know. Once in a while, the answer to my question is nowhere near what I expected.
Disclaimer time. This one is going to be more for the EMS types reading this. I'll try to not leave any of you non-medical folks in the dust, but if there are questions, ask me. Just leave it in the comments below.
We get dispatched to an unresponsive person at about 1:50 in the morning. En route, dispatch gives further information that the patient has snoring respirations. I know, it's almost 2 A.M., you should expect unconscious and snoring, right? To be honest, that's what I expected to find.
On scene, the patient is found laying on the living room floor. BLS first responders and a deputy are on scene, and tell us the patient is awake. so far, so good.
The patient is a 21 year old female, no significant past medical history, no regular meds, no allergies. Earlier in the day she had complained of nausea, headache, and neck pain, and was seen at an urgent care clinic, where she received Toradol, promethazine, and diphenhydramine injections. After coming home, the patient continued to complain of pain, so took a 5/500 Lortab, with no effect. She's awake but very confused and restless. Exam is unremarkable, with no nuchal rigidity. While we're on scene, the patient has a tonic-clonic seizure lasting about 30 seconds. She comes out of it, and is classically post-ictal. So now the picture is somewhat clearer, and I'm thinking meningitis. We scoop her up to the cot and head for the ambulance.
In the unit, we start an IV, check blood sugar and temperature, then apply an EKG and some oxygen. Sugar is well within the normal range, and there's a very low grade fever at just over 99 degrees. Pupils are equal, round, and reactive, if slightly constricted. Still thinking meningitis. The EKG shows a sinus tach, and the 12 lead is normal. Off to the hospital.
During transport, the patient wakes up a bit more, and becomes agitated and combative. I spent half the ride trying to keep her from coming up off the cot and trying to jump out of the ambulance. Get to the hospital quickly, and hand her off. The ER works her up with the usual package of labs, urinalysis, drug screen, and CT, all of which didn't really show much out of the ordinary. A lumbar puncture was performed, getting some pink, cloudy fluid with some red blood cells and white cells at 10. Yep. Meningitis. The patient gets admitted to ICU a few hours after arrival.
A neurologist was consulted, and also arrives at a diagnosis of meningitis, probably viral. If you're going to get meningitis, viral is the one you want. It just makes you sick, unlike bacterial, which tends more toward the lethal. Acyclovir, vancomycin, and rocephin are administered with some improvement in condition, and the decision was made to transfer the patient to a larger hospital in Kansas City for a stay in the Neuro ICU. Case closed, right? Nope.
The transfer was uneventful, and the patient was admitted with probable viral meningitis. The neuro team there orders an MRI. Before the MRI, all the routine screenings, to include a pregnancy test, have to be done. Patient is pregnant. And hypertensive. And seizing. Could it be...? Yep. Pregnancy induced hypertension, AKA pre-eclampsia, AKA toxemia of pregnancy. WTF? Really? Uh-huh. One emergency c-section later, and patient is better, her 24 week infant is in NICU, and we're all scratching our heads.
One of the things you're taught in paramedic school (Or any medical education, for that matter.) is that if you hear hoofbeats, you should start looking for horses, and not zebras.
But don't be surprised if one of those stripey bastards sneaks up behind you and bites you in the ass.
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