Monday, 22 December 2014
rendezvous - Beta 0.3
Case Study 10 January 2009
Article Index
Case Study 10 January 2009

The Setting
It’s early September.  You’re leading a college orientation group on a four day backpacking trip.  It’s 1500 hrs (3:00 PM) on a nice, sunny day.  You arrived in camp about 30 minutes ago.

Suddenly you hear one of the participants yelling “Jerome is having convulsions!”  You remember talking to Jerome about his history of seizures and that he has not had a seizure in a year. You walked quickly to Jerome.  Your heart is racing, your palms are sweating and you feel your breathing quicken as you click into the habit of scene size-up and initial assessment.   Jerome is actively seizing with a spoon tinged with blood in the corner of his mouth.

You kneel next to the patient and cradle his head in your hands.  You remove the spoon from his mouth.  He seems to have an airway and is nosily breathing, which improves when you wipe saliva from his mouth.  There is no active bleeding and no obvious injuries.  Jerome is not responding to voice or pain.  You look around and see a lot of anxious campers staring at the scene.  You tell them it’s a seizure, Jerome will be ok and ask them to calm down while you think….vitals….head-to-toe….sample.  

SOAP Report
Subjective/Summary/Story
The patient is a 19-year-old male whose chief complaint is seizure activity. Patient was in camp when he was witnessed rolling out of his “crazy creek” chair onto the ground where he actively seized with generalized muscle contractions for approximately 45 seconds.  I witnessed the final 10-15 seconds of the seizure, saw generalized muscle tremors, and removed a plastic spoon from the patient’s mouth. The patient is currently unresponsive.

Objective/Observations/Findings

Patient Exam:
The head to toe revealed a half-inch laceration on the tip of the tongue. Airway is otherwise intact. No other injuries were found.


Vital Signs 

 TIME  
 1500 hrs
 LOR  Unresponsive.  Patient does not react to pain stimulus.
 HR  100, strong, regular
 RR  22, regular, noisy
 SCTM  Pale, Cool, Clammy
 B.P.  Radial pulses present
 Pupils  PERRL
 T°  Not taken


History

Symptoms:  Patient is unresponsive.
Allergies:  Unknown
Medications:  Dilantin for his seizures at 100mg three times daily.
Pertinent Hx: History of seizures.  Seizure free for one year.
Last in/out:
Bystanders say he was drinking water all day and ate lunch.  Patient urinated during seizure. 
Events:
Hiking, then this seizure.


What is your Assessment and Plan?  DO NOT click/peek at the next page without answering this first. 

Click here for page two.

 


 


< Previous   Next >
Check out more photos like this one in The NOLS Photo Group at www.flickr.com

Login/Logout
User Menu

 


Home Locations Departments Faculty News and Reports Help Home Dream Sheet Blog New Employee ProDeals Who's who? Message Board Links Admission & Marketing Alumni & Development Curriculum Finance, Purchasing & Mailroom Human Resources Information Systems NOLS Professional Training Operations Public Policy Risk Management Wilderness Medicine Institute Grading Notebooks Staffing WMI Links Newsletters Managers' Notes EDT Forum Board Reports Help Desk FAQ NOLS Home About Us Courses Wilderness Medicine Institute NOLS Professional Training Alumni Store Donate Account NOLS Home About Us Courses Wilderness Medicine Institute NOLS Professional Training Alumni Store Donate Account WMI Home About WMI Courses Schedule FAQ Photos & Movies Curriculum Updates Employment Sponsors Find a Course Skills Financial Aid College Credit Photos and Movies NOLS Home About Us Courses Wilderness Medicine Institute NOLS Professional Training Alumni Store Donate Account Photos & Videos Home NOLS Photos NOLS.TV The NOLS Podcast NOLS on Flickr WMI Home About WMI Admissions Courses Schedule Host a Course Resources Gallery