30ish male wheeled to room from triage. Slumped over in wheelchair. Able to move to stretcher with a lot of assistance from 2 staff members. Per parent, pt was "fine today". However, pt went to bathroom, came out, "was not himself, he was lethargic and keeps zoning out, so I brought him in".
Pt responds to touch but cannot or will not answer questions, skin flushed, warm and dry, hr 160, bp 90/50, rectal temp 102.6, rr 28, pulse ox 95. Hx is psych and etoh. Per parent, pt saw psychiatrist this afternoon and was recently released from rehab.
Nu? Whatcha gonna do? Whatcha thinking? Whatcha wanna know and what're your priorities?
The suboxone is for opioid dependency and has narcan in it. Maybe the patient didn't take his suboxone? Seroquel is an antipsychotic which can have nasty side effects. Maybe he is having side effects to the seroquel. Are any of these meds new for the patient?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
But what should be done?
Fluids of course. O2 of course. Consider intubation. Consider overdose. I would consider neuroleptic syndrome or they drank with the Antabuse.
The temp makes me lean towards NMS neuroleptic malignant syndrome is a rare, but life-threatening, idiosyncratic reaction to a neuroleptic medication. The syndrome is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
Since I mentioned it what is the drug used for NMS with hyperthermia?
Fluids of course. O2 of course. Consider intubation. Consider overdose. I would consider neuroleptic syndrome or they drank with the Antabuse.
The temp makes me lean towards NMS neuroleptic malignant syndrome is a rare, but life-threatening, idiosyncratic reaction to a neuroleptic medication. The syndrome is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
Since I mentioned it what is the drug used for NMS with hyperthermia?
Would the muscular rigidity make his BP go up, not down?
Fluids of course. O2 of course. Consider intubation. Consider overdose. I would consider neuroleptic syndrome or they drank with the Antabuse.
The temp makes me lean towards NMS neuroleptic malignant syndrome is a rare, but life-threatening, idiosyncratic reaction to a neuroleptic medication. The syndrome is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
Since I mentioned it what is the drug used for NMS with hyperthermia?
Dantrolene. I remembered it then googled to check :)
We addressed the fever with tylenol 650mg pr. Pt was tubed to protect airway. And the doc was real interested in what csf might look like.... So what do think happened after tubing?
Esme12, ASN, BSN, RN
20,908 Posts
You are on the right track...I think ....with the meds. That alcohol med is antabuse which the patient is on. What about the other meds mentioned?
But even before considering the meds...what is the fist thing we should do with periods of apnea and a low O2 sat?