In 1973 pt (age 18) was huffing aerosol deodorant (halogenated hydrocarbons) through a filter made of toilet paper. After inhalation of 2 cans, pt became disoriented followed by agitation and collapse. There was cessation of heartbeat & breathing - friends took pt to ER and performed CPR en route 2-3 times. Upon presentation, pt was flat-lined on EKG - successful rescuscitation with closed chest massage and ventilatory support.
This event happened prior to development/use of the Glasgow Coma Scale and I am trying to determine an estimated GCS score and would appreciate another opinion.
Following rescuscitation pt had intermittent decerebrate posturing with no corneal or abdominal reflexes and totally unresponsive except for a pupillary response. Pt admitted to ICU with endotrach in place and remained unresponsive as noted in prior sentence for 18-24 hours. Over the next few days pt remained somewhat unresponsive although at times would cry out (at different times spontaneously cried out - he made me do it, mother, father, names of friends). After 3 weeks pt was transferred to larger hospital for neurological eval. In the days prior to transfer, pt had progressed and was able to sit up in bed and would cry out occasionally. Nasogastric tube remained in place as did catheter.
Upon admit at transfer pt had temp 38 centigrade, bp 130/100. Not alert. Somewhat unresponsive to verbal commands. Quite agitated with excessive restlessness and increased physical activity and crying out episodes. Pt could doll's eye, fundoscopic exam revealed well-defined circumscribed disc margins. Corneal reflex direct and consensual bilaterally. Good pupillary light reflex. Reflexes somewhat diminished in ankles bilaterally. Absent left abdominal reflex. Unsustained clonus bilaterally. No Babinski. Active Hoffman's bilaterally.
During 2 week stay at 2nd hospital SMA 6 was wnl. One SMA 12 value reported SGOT of 141. EKG sinus tachycardia but otherwise wnl. On 2d day of stay nasogastric tube removed and pt gradually started taking pills, fluids and food with encouragement. Persistenly and daily pt had crying out episodes and episodes of extreme emotional lability during which there was a great deal of motor activity. Pt would respond to verbal command and could talk although somewhat incoherently and had a dysarthria. Recent memory poor although past memory fairly well intact. Disoriented at times as far as place. EEG revealed abnormal waves indicative of generalized encephalopathy. Pt revelaed changes consistent with organic mental syndrome secondary to inhalation of halogenated hydrocarbon which caused previous cardiopulmonary arrest and led to anoxic brain damage. Pt discharged to home 31 days post-event in hopes familiar surroundings would aid in adjustment to new condition.
It appears that this pt is a rare survivor of what is now known as "sudden sniffing death". Consequently, I can find very little information regarding outcomes hence my attempts to determine GCS. I am trying to determine if her estimated GCS was a reliable prognostication of outcome. Any help would be appreciated.
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