Age: 17.0
Sex: M
Vaccine: HEPA, TDAP
Symptoms: Pallor, Posturing, Pulse pressure decreased, Speech disorder, White blood cell count increased
Clinical narrative: Patient came into the clinic to update his immunizations for college. All questions on immunization consent form were asked to mother and she answered no to all. After discussion the client and his mother decided to get the TDAP and HEP A vaccine. The patient was sitting on the exam table when the vaccines were administered. The patient, his mother and myself left the first exam room and walk approximately 10 feet to another exam room when the patient stated "I feel like I am going to pass out" he sat down in the chair immediately and slumped over to the right losing consciousness and I caught him before he could hit the floor. I leaned back up where he was resting his head on his mother's chest. I immediately called for RN to bring me a blood pressure cuff. During the time she was getting the cuff the patient seem to have a seizure as evident by a blank state, head thrown back, and decorticate posturing. I then advised PHT to call 911. I put the BP cuff on the patient and attempt to get a reading, however the machine would not pick one up. The patients pulse was present but slow and weak. I advised RN to get a wet cloth for the patient and she did and gave it to the patient's mother who applied it to his forehead and face. The patient was cold and clammy and mumbling. I advised PHT to get the Emergency medical supplies from the lab and attempted to repeat the blood pressure. The reading was 77/54 02 Sat was 90 on room air and pulse was 34. The patient appeared to then have another seizure and showed the same symptoms as above and then lose consciousness. At this pint I advised that we need to move the patient to the exam table. The patient was picked up from the chair by his mother, PHT, and me. After placing the patient on the table I advised PHT to elevate the patient's legs. The patient started to gain consciousness and his blood pressure at this point was 101/53, pulse 60, O2 Sat 99, EMS on scene. Continued to monitor patient. Blood pressure reading of 99/69 and 112/68. Patient remained in supine position while evaluating BP. Patient started getting some color back. EMS had patient sit on table for a couple of minutes. We then had the patient stand and repeated the blood pressure at which time patient experienced dizziness, turned very white, and started to appear to lose consciousness again. Blood pressure cuff would not even read due to orthostatic hypotension. We immediately placed patient back in supine position. EMS advised pt should probably be seem by ER or personal M.D. Patient's mother contacted M.D. office who advised her to have EMS take him to the ER. Patient was transported by EMS to Medical Center. Patient's mother at approximately 1:15. She advised that her son had been released from the ER. Blood work had been performed that demonstrated slight elevation of WBC's. EKG was normal. She also reported that the patient received 2 liters of Normal Saline. She reported that she is to follow up with her son's primary physician to see if he should get the second of HEP A.