Author: Jeffrey Ham, DO
Co Author #1: Jeffrey C. Ham, DO
Co Author #2: Ralph Mills MD
Editor: Charlie Michaudet, MD
Senior Editor: Margaret E Gibson, MD
A 17 Year old male has increased work of breathing and syncopal episode after football practice in September.
A 17 year old offensive lineman begins breathing heavily and then collapses, becoming unresponsive, after a September football practice where the temperature was 85 degrees. EMS is called and arrives on the scene where the patient appeared to be in tonic- clonic state. Seizures, lasting 8-10 min, were unbroken until the patient was brought to ED and given an IV dose of Valium (5 mg). The patient was noted to be cool, pale, and diaphoretic with a core temperature of 104.9. He subsequently had an episode of vomiting and then began more tonic-clonic movements. He was then given a 1 mg dose of Ativan, followed by intubation. He was transferred to a cooling bed and received 1 L of fluids rapidly. Labs were then drawn, head CT was obtained, and the patient was admitted to Pediatric ICU, with additional tonic-clonic activity in route to PICU.
VS: Temp 100.9, pulse 117, respirations 22, blood pressure 104/49, and O2 99% on vent
GENERAL: Sedated and unresponsive to verbal stimuli, withdraws to painful stimuli
HEENT: Pupils were reactive to light and had a positive corneal reflex.
CARDIOVASCULAR: hyperdynamic precordium with strong pulses and tachycardia, capillary refill less than 2 seconds, no murmurs
PULMONARY: lungs were clear to auscultation bilaterally with no wheeze, rhonchi, or rales
ABDOMEN: soft with no hepatosplenomegaly, positive bowel sounds with multiple foul-smelling liquid bowel movements during the exam, bright red blood per rectum
GU: foley in place, no scrotal edema
EXTREMITIES: no edema, no clubbing, no cyanosis
NEURO EXAM: deep tendon reflexes are 1+
SKIN: rash under bilateral pectoralis muscles from shoulder pads
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