How Do We Evaluate, Treat, and Disposition New ….pptVIP

How Do We Evaluate, Treat, and Disposition New Onset Seizure Patients? KHALID MBAYA (M.D) SUPERNUMERARY REGISTRAR JOINT DIVISION OF EMERGENCY MEDICINE UNIVERSITIES OF STELLENBOSCH AND CAPETOWN A 25 years old female, known RVD +Ve not yet on ARVs, with CD4 counts of 95, is reffered from MDHS to GFJ on 24/01/2010 .Reason for referral is to do CT scan of brain because the patient had an episode of seizure followed with confusion few hours ago. The patient was given a stat dose of Ceftriaxon 2gm at MDHS before transfer to GFJ. Questions Why the patient was given Ceftriaxon 2gm? What do you think was the diagnosis of this patient in the mind of referring doctor? What reasons could probably made him to request CT of brain? -Afraiding of herniation of intracranial mass if he does LP? -Formality? Standard of care? -To confirm diagnosis? The patient arrived at GFJ hospital on 25/01/2010 at 00h30. Vitals: B.P 108/75 mmhg, Pulse 88/min Temperature 35.5°C, Hb 8.4 Vx 7.7 Collateral from the mother: The patient had a fit in the morning and was unable to to talk for about 5minutes.she peed on herself.After that episode the patient remained confused untill they arrived at the day hospital. The patient is not known to be epileptic and was scheduled to start ARV clinic next day. On examination: The patient looks calm, oriented to TPP. Normal physical and systemic findings. Blood was drawn for EUC and FBC, and results was: Na 135, K 4.6, WCC 7.6, Hb 10.9, Platelets 561. Due to normal neurological findings, LP was done and 10mm3 of clear fluid under moderate pressure drawn and sent to the lab. Results were obtained just before the morning ward rounds. Poly 0, lymph 0, Eryth 72, gluc 3.6, indian ink –ve, culter pending. 24/01/2010 at 0800 W/R with int.medicine consultant Dr.Nyo: -Why did you do LP? That is very dangerous -Since the LP results are normal, and patient looks fine, plans are as follow: 1.Descharge the patient to come back the next day fo