> > H+,
> > CO2, WBC, Na, PT, Ca etc would be useful even if normal.
> >
> > Matt Dunn
> > Warwick
>
> As in normal, not as in not done. ECG also unremarkable.
Makes it more interesting. Hydrogen of 40 and normocapnia makes true fitting
pretty unlikely (nearly always a metabolic acidosis with usually a
respiratory acidosis).
As you say,
> Fitting for
> a considerable period of time will lead to hypoxia,
> hypercarbia, a fever and a mixed acidosis.
If bloods are OK, I'd keep up supportive care and go for the scan- although
I'm not convinced that the anisocoria is acute I agree with Rowley that in
an unconscious patient it shouldn't be ignored- particularly with a history
of head injury and loss of consciousness even in the absence of external
evidence of injury.
Normal ECG in terms of QRS and QT pretty much rules out fitting from cyclic
antidepressant OD (there was a paper on this about 3 years back somewhere-
anyone got the reference to hand?)
BTW, someone wrote on the list a few years back about using a 6 lead EEG in
A and E. If I had one (which I don't and no intention of getting one), I
might use it in this case.
> Sorry Matt, a small point I know, but isn't incontinence
> associated with
> cholinergic effects, not anticholinergic effects?!
Sorry, yes. Problem with learning to touch type- I can type 40 wpm but only
think at 30. I think I was thinking of organophosphate poisoning for some
reason. Can be found in a whole host of other poisonings though- most
commonly alcohol.
> and there is a degree of
> difficulty in my mind pinning all this down
This is worrying. I put a lot of store by gut feelings from the person on
the spot.
Matt Dunn
Warwick
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