ED pt: 58 years. Hx of schizophrenia, anxiety, MI 5 years ago, and HTN. Home meds unknown. Hyperventilating upon EMS arrival. Could control hyperventilation when asked to, but then would start again. If pt alone in room, no hyperventilation. When addressed by staff, would begin hyperventilating again, then calm down.
This continued intermittentently x 1 hour. During this time labs normal, O2 sats normal, hypertensive around 150/90ish, normal HR (80-90s). Normal urine drug screen (benzos prescribed). Chest xray normal. Kept removing O2 and roaming in halls. Ate a meal. Was very anxious but conversant. Decided to CT chest to rule out PE, on way to CT, hyperventilated entire way in wheelchair, began to sweat profusely and turn gray. Placed on monitor and prepared to code during CT. All VS normal in CT. Negative for PE. Also scanned head, nothing acute. Continued to hypervent, but level of consciousness diminished.
Upon arrival back in room, pt became apneic for 5 seconds and resumed hyper resp, then became apneic for 5 seconds again as we were preparing to intubate. Tubed quickly and placed on vent. No cardiac arrest.
MD perplexed as to the cause of all this. ABGs showed normal PO2 and low Co2. Some theorized that pt did this to himself by hyperventilating. What do you think? Any experience with this? Thanks!
Ran into family member of pt today. He is still in ICU 4 days later. They were going to try to take him off the vent today. I wish I had more info, wanted to go to ICU, but today was ambulance after ambulance after ambulance in my rooms. Thanks for all the great info.
Sort of sounds like the crazy schizo type we all get to be witness to. There is a young girl you loves to frequent our ER. She is 14 has multiple mental health diagnoses, including pseudo seizures, and she is amazing at displaying symptoms of these. Another problem, she actually has seizure history, so anytime there is a pseudoseizure...off to the ER she goes. Her pseudoseizures have become so well reheorificed that she even urinates herself. This had not started until one of our nurses pointed out the fact that people often urinate or defecate when having seizure activity. We have yet to see any acts of defecation from her, though. Eventually, the "little boy who cried wolf" story plays true.
hiddencatRN, BSN, RN
3,408 Posts
I'm apneic for 5 seconds all the time.