I agree. Not to transport was unacceptable.
Whilst an elevated pulse rate at 1 hour may suggest a cerebral event there
are many non-cerebral causes of seizures including arrhythmias.... that
include self-terminating VF.
I remember bringing in an AMI to Rowleys hospital many years ago who
arrested just outside the A&E. It was a 20 second tonic-clonic event where
blood shot out of his nose and hit the back doors of the ambulance 5 feet
away! Following successful defibrillation, the following day in CCU he had 2
most impressive peri-orbital haematomas! Hardly the 'classic' hypoxic/anoxic
fit.
A pulseless VT with minimal cerebral perfusion can cause seizures for over a
minute.
Seizures - cause unknown - transport!
Regards
Dave Fletcher
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, November 17, 2006 8:12 AM
Subject: Re: 48 y/o male 1st fit
> What was the cause of his seizure?
>
> The most likely reason he vomited blood was he had a fit. There is
> always a differential diagnosis, and with a tachycardia he may easily
> have had a GI bleed sufficient to drop his blood pressure so that the
> fit was as a result of a poor brain perfusion. A pulse rate of 120 AN
> HOUR after the fit is not usual. I acknowledge his blood pressure was
> now normal, but he has had an hour to compensate and I bet it was not
> performed standing.
>
> I find nothing to criticise in the crew's actions until bizarrely, they
> decide not to transport. Although I understand the rationale of making
> the ambulance clear for further calls in my view it is at the expense of
> this patient - the one they already have.
>
> Perhaps the most worrying feature is that nothing they did explained the
> fit, and the risk of subsequent fitting is high in this acute phase.
> Expecting a member of the public to protect the airway is quite
> unacceptable. I do not find they acted safely or in the patient's best
> interest.
>
> /Rowley./
>
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