Twenty minutes after your arrival you repeat your assessment.
Over the next 10 minutes the patient aroused to A+Ox2, then gradually to A=Ox3/4. He denies any pain or tenderness other than to the tip of his tongue.
|TIME||1500 hrs||1520 hrs|
|LOR||Pt does not react to pain stimulus.||A+Ox4|
|HR||100, strong, regular||80, strong, regular|
|RR||22, regular, noisy||14, regular, unlabored|
|SCTM||Pale, cool, clammy||Pink, warm, dry|
|B.P.||Radial pulses present||Radial pulses present|
|T°||Not taken||98°F oral|
|Medications:||Dilantin for his seizures at 100mg three times daily. Patient states he took his scheduled dose today and previous days.|
|Pertinent Hx:||Pt reports a history of seizures secondary to a head injury six years ago; he has not had a seizure in a year.|
|Last in/out:||Pt stated he is well-hydrated with three liters or water today and ate lunch. Urinated during seizure. Otherwise, normal urine and bowel movement.|
|Events:||Pt hiked four miles, arrived in camp, sat down to rest, and had one seizure.|
In most cases an isolated seizure in a patient with a history of seizures should be evaluated by a physician but does not necessarily require a rapid evacuation. These occasional seizures are often due to changes in the patient's need for medication or failure to take the medication as prescribed. After recovering from the seizure, the patient should be fed, hydrated, and assessed for any injury that may have occurred during the seizure.
Jerome rests for an hour, then eats a good meal. He thinks this is an isolated seizure, perhaps due to the change in his activity level, and that if he doubles up on his medication for a short period he’ll be fine. He does not want to be evacuated. You don’t disagree with his perception of the situation, but your program has a set of medical protocols that clearly call for evacuation if a patient has an isolated seizure. If the patient has multiple seizures or seizures secondary to a known medical problem such as a blow to the head or diabetes, then your evacuation should be rapid.
Jerome feels up to a hike to the road, so you set out late afternoon and arrive at the trailhead by 9:00PM. After being seen by a physician, he is cleared to return home, but not to the field.