everyone is stumped

Specialties MICU

Published

So here's the scoop. I work in a small community hospital- a general ICU. The bottom line is- everyone- including our doc's are completely stumped. Here's the details...

57 y/o female

HX: HTN, depression, MI, cardiac stent x2, lap chole 2006, non-IDDM.

At home- house was treated for bugs- (bombed is what I got in report)

after approx 3 hours, EMS called by friend stating pt has a seizure.

Pt brought to ER- Combative, agitated, non-verbal, hypertensive (212/110), tachycardic (140-160's) kussmaul respirations, low grade fever (100.9). FSBS 236. BUN 21/creatinine 2.1

Pt transferred to PCU- continued HTN 200's/100's with PRN Hydralizine order. after 1 hour on PCU order to Tx to ICU- no order for Nipride or Labetalol.

Pt continued as above- pt appears diaphoretic- EKG- ST/SVT 150-160. Adenosine given- no response.

CT head- small white matter changes- appear chronic. NO ACUTE PROCESS SEEN.

Any ideas- nothing- not Ativan, Haldol, or Valium calmed her down. None of the doc's seem to have any ideas as to what is wrong with her. I consider myself pretty smart- but for the life of me- I can't figure this one out. we gave her Dilantin IV b/c they thought she may be having seizures- but honestly I don't think thats whats going on. Her ETOH and Tox were neg.

thanks for any input....

Specializes in STICU, CVICU, Flight.

I'm still curious-what causes green sweat?

Thanks everyone for your input. Sadly, this pt did not survive. Later, we found out that she had sleep apnea and the MD's believe that she prob had some sort of reaction to the house fogger and b/c of her apnea started having resp distress. Then due to the distress with combo apnea became hypoxic and had a seizure. Unbelievably, after a fentanyl, ativan, and diprivan gtt, she became hypotensive- even after they were d/c'd - had to start Levo. Anyway- thanks for everyone's input- it was a wild ride!:nurse:

we had a patient who had hypoxic respiratory failure because her housekeeper used a bug spray (I think it was Raid) as a furniture spray (I guess she thought it was Endust or Pledge!) Anyway, the patient had severe methemoglobinemea which we treated with methylene blue. I don't remember anyone commenting on green sweat, though.

Specializes in ICU-my whole life!!.
Intubate her and start her on Propofol and be done with it! Would probably fix her blood pressure too lol

Bingo!

Specializes in MICU/SICU.

why no nitro or cardene?

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