Two hours...

When the patient arrived at 9:10pm, the EMS report was basically an altered level of consciousness, fast heart rate, possible dehydration (as the home had no A/C)...

When moving the patient from the ambulance stretcher to the ED bed, it was recognized that the patient was actually having a seizure...

The IV fluids were opened wide, Ativan was administered, monitors applied, and a quick assessment... the patient's core temp was 103+  Immediate ice packs to the axilla and groin, cool IV fluids, tylenol...  second IV and bloodwork (labs) drawn.

Still seizing, more Ativan...

Still seizing, time to get the ED physician.

The patient was given more Ativan.  The decision made to do a RSI intubation.  NG tube and a temperature probe foley placed.

Seizure stopped, core temperature starting to come down.  A Lumbar Puncture, Propofol drip started, more cool IV fluids, an Arterial line initiated to monitor B/P in realtime...

More labs are drawn, off to CT Scan, and IV antibiotics are started.

Report called, and patient transported from CT directly to the ICU at 11:15pm.

Two hours from arrival in the ED to the ICU... not bad.

But the weird thing is that the patient arrived two hours after the start of my shift, had two hours of Intensive Care provided by me, and two hours after they got to the ICU, I got to "flex down" and leave early!

I had contact/cared for only five patients in my short six hour shift.  My two other patients during this resuscitation, received the benefit of one of the greatest Emergency Teams I have had the privilege of working with!  Not only was I given the support for my "critical" patient, but the two other patients in my assignment at the time were being monitored and taken care of!

At the time I left, we still didn't know if the patient was septic and seized due to their temperature, or was it a heat injury, or was it a fever due to prolonged seizure.  But a temperature from 103+ down to 99-ish, pulse from 160 down to 99, B/P from 180/100 down to 100/70...  let's just say these are very positive trends.

All this on my last shift of a 5-day in a row marathon...

Right place, at the right time.


Peace!