itku2er Posted March 19, 2009 Share Posted March 19, 2009 You are called to a LTC facality. You have the following patitent 73 yo male sitting in a wheel chair is drooling and both hands are shaking. Patient is talking but not making sense. He looks at you and says I really like you but you are a duck and ducks are dirty and smell. BP 160/60 HR 120 RESP 24 Temp 98.9 BS 177 The report you get from the nurse is as follows. Patient was sitting in his wc when all the sudden he started shaking and drooling he wouldnt talk just stared into space. Not able to follow verbal commands. Nurse stated onset of symptoms were 5 min before 911 was called. Link to comment Share on other sites More sharing options...
EMT COASTIE CHICK Posted March 19, 2009 Share Posted March 19, 2009 I don't understand why you are asking did i miss something.....what are you wanting to know?? Or were you just telling us? Have a good night. Link to comment Share on other sites More sharing options...
FireMedic65 Posted March 19, 2009 Share Posted March 19, 2009 I don't understand why you are asking did i miss something.....what are you wanting to know?? Or were you just telling us? Have a good night. Look at what part of the forum you are in. This is a scenario. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted March 19, 2009 Share Posted March 19, 2009 (edited) Facial droop? Arm drift? Do we have any past history for him? Actually, let me get a full sample. The nurse said he was staring of and not speaking, but now he's speaking, just not making sense. How long has he been speaking again? Any slurring? Also, any signs of trauma? Edited March 19, 2009 by Jeepluv77 Link to comment Share on other sites More sharing options...
itku2er Posted March 19, 2009 Author Share Posted March 19, 2009 (edited) Facial droop? Arm drift? Do we have any past history for him? Actually, let me get a full sample. The nurse said he was staring of and not speaking, but now he's speaking, just not making sense. How long has he been speaking again? Any slurring? Also, any signs of trauma? No facial droop Arm lift was normal. He is now talking yes but before he wasnt responding at all just staring into space. No truama and no slurred speech. Past medical history: DM CHF COPD Mild hypertention Has a history of being a patient in the Hendersons Research Center. Edited March 19, 2009 by itku2er Link to comment Share on other sites More sharing options...
FireMedic65 Posted March 19, 2009 Share Posted March 19, 2009 No facial droop Arm lift was normal. He is now talking yes but before he wasnt responding at all just staring into space. No truama and no slurred speech. Past medical history: DM CHF COPD Mild hypertention Has a history of Hendersons disease. ALS available? If so, EKG? Are vitals taken by us for the nursing staff? Link to comment Share on other sites More sharing options...
itku2er Posted March 19, 2009 Author Share Posted March 19, 2009 ALS available? If so, EKG? Are vitals taken by us for the nursing staff? The crew is a Paramedic EMT B and EMT I You take the VS and they are close to the ones the NH staff took. Link to comment Share on other sites More sharing options...
vetlemakt Posted March 19, 2009 Share Posted March 19, 2009 (edited) I would think this one is a cerebral case - and would probably stay convinced until proven otherwise by a negative CAT. Sitting on the toilet -> intra cranial pressure (?), drooling, speech problems. Blood sugar levels at 177? Is that a normal figure in the US (normal in Norway: 3,5-6,0)? If he was far from hospital, we'd heli him in. If by car, IV saline, O2 as long as SAT<94%. Paracetamol 1000mg rectally. That's all normal procedure for me, though. Can't see how I would have treated or viewed the pt in any other way. EDIT: EKG? Pupils? I'd administer some Metaklopramid (anti-nausea) as well, as a profylactic. Edited March 19, 2009 by vetlemakt Link to comment Share on other sites More sharing options...
itku2er Posted March 19, 2009 Author Share Posted March 19, 2009 Link to comment Share on other sites More sharing options...
scott33 Posted March 19, 2009 Share Posted March 19, 2009 (edited) Oh dear. Inferior wall MI. Lead III has taller ST elevation than lead II, so I would want to rule out any right-sided involvement, in spite of the decent B/P at this point Edited March 19, 2009 by scott33 Link to comment Share on other sites More sharing options...
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