An elderly vietnamese gentleman was wheeled in to the ED last night with a chief complaint of "seizures". He had a stroke last year, and ever since has had full on tonic-clonic seizures once a month. He seizes for 2 minutes and spends the next 30 minutes recovering, confused and scared.
Last night, however, his confusion didn't resolve. When his family realized he wasn't getting better, they dutifully called the paramedics who carted him, unresponsive, to the ED where he sat in the waiting room for an hour and a half... until he projectile vomited bright green bile with his head spinning to the left like the Exorcist.
He was promptly wheeled back to my section of the ED, where I was faced with a completely unresponsive man whose head was torqued as far left as it would go. His eyes stared at some distant horizon. His arm was bunched up towards his shoulder and he held his leg up to his chest like a jackknife. Any attempt to move his head or limbs into alignment were met with extreme rigidity.
With horror, I realized that this man was still seizing; and probably had been on and off for the past 2 hours since the family first called the ambulance. His decreased consciousness wasn't simply from postictal confusion as the paramedics thought. He was in status epilepticus, lost to the world as the neurons in his brain went haywire, haphazardly directing his muscles to spasm.
15 milligrams of diazepam later, his neck finally loosened up and his body became less tense. Now there were more serious fish to fry; 2 straight hours of seizure activity had caused a massive lactic acid buildup in his bloodstream, the byproduct of overactive muscle metabolism. We frantically worked to establish intravenous access so we could hydrate him and neutralize the acid.
And at the end of all our hard work? He woke up. Confused, disoriented, fatigued - but fixed up and on the fast track to recovery. His family was incredibly appreciative, and once he realized what had happened, he was all smiles.
It's moments like these why I went into doctoring in the first place.