Acute symptomatic epi attacks in the Operation of emergency medical service: Case report

Abstract

INTRODUCTION: Acute symptomatic epi attacks are attacks that are provoked by temporary action of systemic, metabolic, toxic and other factors with epileptogenic effect (high febrility, hypoglycemia, hypoxia, alcohol, lack of sleep, etc.) or they occur due to acutely induced brain lesions (stroke, meningitis, trauma, etc.). AIM: to present prehospital at-the-scene measures in treatment of a patient with acute symptomatic epi attack. to point out the significance of correctly taken anamnesis and the dispatcher's role in the operation of Emergency Medical Service Teams. MATERIALS AND METHODS: A descriptive overview of data, a dispatcher's protocol , a physician's protocol, and 2005 guidelines of good clinical practice for consciousness crises, the patient's discharge note. CASE STUDY: At 3 minutes past 12, the emergency team received a radio call that a female person 58 years of age lost consciousness. The dispatcher gave the information that the patient lost consciousness, that she was shaking, had turned blue and was breathing very heavily. The patient was found awake, confused, cyanotic, with traces of blood on her lips. The primary examination showed that the patient wasdyspnoic, with diminished breath sound over lungs, with extended expirium, presence of polyphonic wheezes over both lungs. SaO92%, rhythmic heart action, tachycardic, about 110/min. TA 160/100 mmHg. Abite was noticeable on the right side of the tongue. According to the consciousness crisis protocol, the temperature was taken, T 36.8 C, and glycemia 3.2mmol/l. A general neurological finding indicated slightly larger pupils, with a normal reaction to light, meningeal signs were negative, there were no signs of pyramidal lateralization. It became clear that the patient had an acute symptomatic epi attack. A question was raised whether the cause of attack was hypoxia, aminophylline overdose, or mild hypoglycemia. The patient remained confused all the time; she did not cooperate during examination. The dispatcher confirmed through the radio system that the patient did not have any epilepsy treatment and that she was an insulin dependent diabetic. Intravenous route was provided, and solution of 10% Glucose 250ml, corticosteroid therapy and oxygenotherapy were administered. The state of consciousness of the patient improved completely during transportation to the Admissions Department of Valjevo Hospital. CONCLUSION: In order for the treatment of these patients to be successful, it is necessary to recognize in the shortest possible time interval the symptoms of acute symptomatic attacks, taking into consideration that they do not have medical and social consequences of epileptic attacks and are not treated by administering antiepileptic medications. The therapeutic approach is based on the treatment of primary disease, i.e. elimination of immediate provoking factor.

Keywords

• epi attack
• hypoxia
• hypoglycemia