“I thought it was a little strange that he had a long-sleeve shirt on when the evening is so hot. When I cut off his shirt, he had big track marks from IV drug abuse all the way up the arm, and on his other arm. He felt warm to me right away, but then it was clear when I felt his forehead. A person who’s having his first seizure, has a high fever and is an IV drug abuser usually has a dangerous infection of some type, so it’s best to protect everyone involved in his care. It’s obvious his father knew nothing about that, and it’s much better for the ED staff to do the necessary testing and explain the whole course of events to the family. But it is important for us to take precautions for the emergency providers and not alarm the family until more information is available.”
The crew has to return to service, but the emergency physician is on for the night shift and promises to contact the paramedic before the night is over with information about the patient. As it turns out, he can share the information face to face: About two hours later the crew brings another patient to the ED, and the physician tells them the original patient has a brain infection caused by the drug abuse. It is not the form of meningitis caused by bacteria and will not require follow-up for the emergency crew.
The patient also has pneumonia, which was likely the reason for the low oxygen saturation level seen by the Attack One crew. Fortunately, he’s now regained consciousness and will be admitted to the ICU.
The emergency physician also said he’d had a lengthy discussion with the father and let him know the cause of the illness and other problems associated with intravenous drug abuse. The father was caught completely by surprise, explaining that the son had gone to college after graduating from high school and had been working and living with friends. He lost his job about a month ago and had just returned to his parents’ house when he was ill. The father wanted to know if this all could have happened in the last month, and the physician told him it appeared the drug use had been going on for a longer time.
The patient had a very difficult hospital course but was finally discharged with follow-up at a drug-counseling facility. His parents took him into their home with the condition that he could not have any of his old friends in, needed to stay clean and had to maintain good status in college.
Sudden and unexpected seizure activity in a child of any age is a frightening experience for parents. If the patient continues to have seizure activity in the presence of the EMS crew, they should take measures to control it as soon as possible. The use of intranasal midazolam, which delivers the antiepileptic medication directly to the blood and cerebrospinal fluid via the nasal mucosa, is safe, inexpensive, easy to learn and provides better seizure control than diazepam.1,2 The atomization device is an excellent method to administer medications without the need for an intravenous line.
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With the changing economy, more young adults live with their parents to older ages. In some cases the parent is still responsible for the health insurance and details of the child’s medical history. In other cases the younger person may be medically independent. When a young person has a serious and potentially life-threatening illness, EMS providers must gather enough information quickly to address emergency care needs. Parents may be the source of critical information necessary for quality treatment, but in some cases the parents are not aware of the child’s recent medical history, and laws at the federal level and in many states give children privacy regarding their medical problems.
In this case the parents were completely unaware of the child’s illegal drug use and could only provide a few details regarding a recent illness. In this emergent situation, where the child is unconscious and the parents are the only source of information, issues of patient privacy are not the primary concern. But EMS providers should consult with their medical directors regarding privacy for other situations regarding young persons. In some cases, the medical problems of the child who is a patient, the treatment administered and other medical history may need to be withheld from the parents due to privacy laws.
Seizures are effectively treated with intranasal medication, but a cause must be found, especially with first-time seizures.