55-year-old man presented to the emergency department via EMS transport after he was found seizing. He was last seen in his prior state of health approximately 45 minutes prior to presentation. Primary evaluation revealed an unresponsive patient with a GCS of 3 who was undergoing full body shaking punctuated with short periods of extensor positioning. Initial vital signs were within normal limits, auscultatory findings of the heart and lungs revealed no abnormalities, the abdomen was soft, pulses in all 4 extremities were easily palpable and symmetric. The patient was intubated and treated for status epilepticus to no effect. An intracranial bleed was ruled out by CT head. A portable chest x-ray revealed a mildly widened mediastinum. Transabdominal ultrasound was performed (Figures 1 and 2).

Diagnosis…

Continue reading September Case →