A week of neuro badness

     This week has been pretty busy, despite the fact that I am supposed to be on "spring break". Now although I don't have class this week, it just means that I worked a bit more. Additionally, all that work involved some very sick patients. One I even transported twice! Once to the hospital for a embolic cva and the second one for a subarachnoid hemorrhage. All of these calls required a lot of work.
     It was all strokes, subdurals, and subacachnoid bleeds this week. Everyone hitting their heads, popping blood vessels, or throwing clots. Not to self, keep blood pressure under control and stay healthy. At any rate, our first bad neuro call of the week was in a hoarder house for a patient presenting with acute mental status changes. I am sure most people have seen the show on TV called "hoarders", so I will skip the description. However, the house was a mess to say the least. So we find our normally cantankerous pt sitting in a chair starring off into space. I know what you're thinking, "DIABETIC! Get the D50%!", however this was not the case. This pt had sudden changes in behavior and was flaccid on the right side. If it walks like a duck, talks like a duck, and has sudden right sided weakness, it is probably a duck...er...stroke. So extrication via the FD and IV, o2, monitor protocol applied and we were off like a shot to the friendly neighborhood ER where this pt immediately went to CT. I didn't see the CT, but they started TPA or clot busters asap because the onset was under 3 hours. This of course bought an ICU bed and a night or two in the hospital.
    Then wouldn't you know it, two days later the same patient developed a subarachnoid bleed and could no longer be managed medically. Call the neurosurgeon! We need to get into the vault and stop the leak. The way to do that was to load this poor patient up and haul butt to the local super hospital for further treatment. But all that required from us was close monitoring and a large dose of diesel fuel.
     The next one was an example of what could happen to someone if they do not take care of themselves at all. They presented via EMS to the local inner city ER with a BP of 300/160. No, that was not a type-o. I said 300 systolic. I am no doctor, but that should be managed a bit better. I'm surprised the patients' head didn't explode! However, their initial complaint was just a head ache which developed into another subarachnoid bleed. This patient required the works. Intubation with paralysis and continuous sedation with diprovan, and IV blood pressure control with Nicardipine. You know the BP is sky high if you need Nicardipine AND Diprovan. Just sayin'. So again, we take this patient priority 1 to the super hospital for neurosurgery. We were keeping those folks in the neuro ICU busy with this seemingly constant flow of critical patients.
    I feel as though we had other critical patients with similar presentations this week. Let's be honest, this week has been a bit of blur. I like the constant flow and actually being utilized as a true MICU instead of slinging renal patients all day long. But everyday is different in the EMS world and you never know what is going to happen.