Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Loss of Consciousness in a Patient With Viral Gastroenteritis
Case Study
A rapid response event was initiated by the bedside nurse for a patient with a brief loss of consciousness. The rapid response team quickly arrived to find the patient resting comfortably in bed. The patient was a 57-year-old female with a history of rheumatoid arthritis on methotrexate admitted for severe dehydration secondary to vomiting and diarrhea and was being treated with intravenous (IV) fluids. Prior to her hospitalization, she was taking care of her three grandchildren, who had similar symptoms of nausea and vomiting. The patient was attempting to ambulate to the bathroom with her nurse’s help. The patient had stood up from bed quickly and subsequently fell back into the bed. She was unresponsive for a few minutes and then regained consciousness without any intervention. After regaining consciousness, she was confused initially but recovered to her baseline within a few minutes. Per the nurse, there was no evidence of any urinary or bowel incontinence or any jerking motions after falling back onto the bed.
Vital Signs
-
Temperature: 98.1 °F, axillary
-
Blood Pressure: 102/58 mmHg
-
Heart Rate: 118 beats per min (bpm) – sinus tachycardia on telemetry
-
Respiratory Rate: 16 breaths per min
-
Pulse Oximetry: 100% on room air
Focused Physical Examination
A quick exam revealed a middle-aged female lying in bed in no acute distress. She was alert and orientated. Pupils were equal, round, and reactive, and there was no nystagmus noted. Her mucous membranes were dry and tacky. Her lungs were clear to auscultation. Her heart sounds demonstrated regular tachycardia without any appreciable murmur, and her radial pulses were strong and bounding. Her abdomen was soft, with mild diffuse tenderness and hyperactive bowel signs but without peritoneal signs. There was no calf tenderness or pedal edema on the examination of her extremities. She was able to recall the events before and shortly after falling back onto the bed. She reports she stood up, felt her vision dimming, and then woke up on her bed with her nurse standing over her. She denied any chest pain before this episode.
Interventions
A cardiac monitor was attached to the patient immediately. Then, 1 L of IV fluid bolus was initiated, given concern for volume depletion. Complete blood count (CBC), comprehensive metabolic panel (CMP), and serum lactate level were obtained, which were concerning for potassium level of 3 meq/L. Stat electrocardiogram (EKG) was obtained, which showed sinus tachycardia. No acute ST changes were seen. Computed tomography (CT) of the head was deferred given the lack of focal neurological signs on exam. The patient was retained on the floor for further rehydration.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here