EMS Paramedic Patient Assessment

An ALS ambulance crew was dispatched to a 69 year old obese male whom upon their arrival was seizing. The crew suspected this seizure was due to his past history of epilepsy, but because of the patients altered conscious state the paramedics had to consider and rule out other possible causes for his convolutions.

Seizures can be caused by many factors. For paramedics, determining the cause is far less important then managing the complications that can be caused by the seizure and to recognize whether the seizure is reversible with treatment.

This assessment depends on the patients conscious state post seizure (postictal). For the paramedics its important to include a thorough history and physical/neurological examination of the patient.

Considering the above and the patient unconscious state, with a GCS of 3 the paramedics have no way of communicating with the patient to help guide their management. County paramedics are required to follow a clinical practice guideline, in which they are required to assess the situation to direct their treatment pathway. Following this guideline, the paramedics checked the patient’s blood sugar level; it produced a recording of a 8.2mmol/L that indicates a normal range and therefore rules out a seizure caused by a hypoglycemia.

Another common cause for seizures an overdose, whether this being alcohol, illegal or even prescription drug induced.

The paramedics can apply an ECG which displays the electrical conductivity of the patients heart. This indicates a sinus tachycardia rhythm (120bpm) which disproves the theory that the patient could be having a tricyclic antidepressant overdose.

To further rule in or out the paramedics current theory of a drug overdose the paramedics can con...

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...l pressure’”(Beebe & Myers, 2011, p.278). This intracranial could be secondary to trauma to the head and intracranial hemorrhage or a tumor.

If the patient does not appear to be recovering, the paramedics should consider performing a more extensive neurological assessment.

But for the patients best interest it is vital for the paramedics to transport the patient to hospital for further investigation and continuity of care.

It is known that patients with a past history of epilepsy often refuse transportation or further care, as these patients usually regain consciousness and have no signs of injury.

If this patient refuses treatment it is best for the paramedics to insure that their vital signs are ‘normal’ and that hypoglycemia hasn’t occurred from the seizing activity. The paramedics must make sure that the patient has made an informed decision.