March 2022: Is It Really a Seizure?

The EMS notification was that a 71-year-old man was going in and out of seizures. His vital signs were stable.I followed the stretcher into the room when they arrived five minutes later. The EMS crew reported that he had previously had a stroke, but he wasn't on any medications for seizure. The family called 9-1-1 because he had been going in and out of seizures for 20 minutes. He suddenly became unresponsive during these episodes, but came back to himself immediately.The patient had another episode while being placed on the monitor. He stopped talking and his limbs shook, and it seemed that his eyes deviated to the left. It looked like a seizure, and of course, the monitor alarm was going off.But looking at the screen changed everything. My patient wasn't going in and out of seizures. He was going in and out of ventricular tachycardia.​Pads went on the chest; an amiodarone bolus and drip were started. No signs of ischemia were present on the ECG, and his electrolytes were normal. A COVID test was sent. (COVID has produced a wide variety of arrhythmias, most commonly atrial fibrillation, but bradycardias and ventricular dysrhythmias have been noted.) A discussion with the patient's cardiologist revealed that this patient had a known low ejection fraction. Wisdom from the expert: Sometimes bad hearts do bad things.Once the patient's ventricular tachycardia was controlled, his “seizures" stopped. In fact, he never had seizures; he had convulsive syncope.Tips to Rem...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs