A Life Saved...thank you Sermo


Intro from Daniel Palestrant, Founder & CEO of Sermo
One physician on Sermo recounts how he harnessed the collective wisdom of his colleagues on Sermo to help him make a life-saving diagnosis.

Originally Posted to the Sermo Community
By: A Hospitalist on Sermo

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A Life Saved...thank you Sermo

Last week I posted a case of a very perplexing and frustrating patient.

https://md.sermo.com/medical/ticket/details?id=48903

Briefly - he was a 57 yo with status epilepticus requiring intubation and mechanical ventillation for 4 days until his seizures were finally controlled. He was successfully extubated but remained restless and agitated. He developed a high fever with no obvious source. He was also tachycardic and hypertensive. There was NO response to benzos or pain medication.

The most frustrating part was that he would not stop moving. Not abnormal movements, just contantly moving all over the bed. We had to restrain him just to keep him from flying out of bed and pulling out all of his tubes. This went on for nearly 3 days with NO relief!

I posted the case and got various suggestions, including Neuroleptic Malignant Syndrome, Seratonin Syndrome, and benzo withdrawal. One suggested just giving him amantadine and that would rule out/in NMS.

I was desperate to help this man, so the next morning I gave him a dose of amantadine. Within 1 hour he was asleep...and he slept all day. I went off-service the next day but just ran into one of the nurses at the grocery store - he is back to "normal" and should be discharged soon.

I am convinced that he might have died if Sermo docs hadn't helped me. How else can a small-town doc on a remote island get specialty consults from all over the country? In less time than it would take me to get a neurologist to come to the phone, I had 10 opinions on what to do.

Thank you!

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