Dustdevil Posted May 7, 2010 Share Posted May 7, 2010 Ok, she's A&O X 3 She knows who the president is and she hates him. she also hates all "Them bastards in washington" She's a keeper! Save her at all costs! If it weren't for the weight and BP, I'd have sworn this scenario was about me. Well, and the gender thing too. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 7, 2010 Share Posted May 7, 2010 Stroke scale? 12 lead? BGL? Does she fall regularly or is this new? Any obvious reason for the fall eg tripped on a mat? Any dizzyness? LOC/GCS? Does she remember everything? What do her friends say happen? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 8, 2010 Author Share Posted May 8, 2010 Does she live alone? Is she able to ambulate, under other circumstances? Is there clear path of egress? Does she have a telephone? > Call the ER, Medical Command, Ask him/her to talk to her about the dangers of dying, should she decide to stay home. > Call PD, they may be able to direct someone to address code violations, thus get her into a place where should could be better cared for. She does live alone She is normally able to ambulate with a cane. She does have a semi-clear path of egress She does have a phone. I called her doctor but no answer. My medical command won't give me the order to transport against someones will when they are A&O X 3 so thats a dead end. PD could come but I didn't think to call them. Cincinnati stroke scale? http://www.strokecenter.org/trials/scales/cincinnati.html Does anyone else have power of attorney so they can override her no? Is this droop something new or noted on your previous lift assists? Request adult protective services to see if they can place her under their custody so she will have to be transported. Any odor similar to alcohol on breath? Fruity breath? Cincinatti stroke scale - abnormal on all counts There is no-one who has power of attorney over her The droop I cannot remember her having but her friends tell me that it's been there for a long time. The patient also says that the droop and weak arm is old. She does have a dry fruity smell from her breath Stroke scale? 12 lead? BGL? Does she fall regularly or is this new? Any obvious reason for the fall eg tripped on a mat? Any dizzyness? LOC/GCS? Does she remember everything? What do her friends say happen? Stroke scale - abnormal 12 lead - not done BGL - still looking for the batteries No obvious reason for the fall Dizzy - now she is after getting her up off the floor LOC - NOPE She remembers everything Friends didn't see anything, she was in a locked apartment for over 24 hours AH HA the batteries are here YOu take a glucose and you expect it to be low with her not eating for over 24 hours. But it's not. Its a whopping 545 You are now arguing with this lady about needing to go to the hospital. She still says no. You've already read in my previous posts that she is A&O X 3 and remembers everything. How do you get her to go? What would you tell her? I have an outcome for you in a few posts from here. It's a doozy. She's a keeper! Save her at all costs! If it weren't for the weight and BP, I'd have sworn this scenario was about me. Well, and the gender thing too. Yes Dust, she reminds me of you except for the weight and the gender. We ended up getting her to go. What are your guesses of her CT scan and Labs? Link to comment Share on other sites More sharing options...
Mateo_1387 Posted May 8, 2010 Share Posted May 8, 2010 I bet her CT scan shows an old cerebral infarction and her labs show that she has acidosis. Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 8, 2010 Share Posted May 8, 2010 Hello, 1. BGL = 545 mg/dl (30 mmol so so I think) Dose she take insulin or is her DM controlled with medications? - Voided twice in last hour - Laying on a urine stain - Looks like DKA or maybe Hyperosmolar Syndrome 2. Renal - On the floor 24 hours or so - Weak left arm - Rhabdomyolysis could be a possibility as well 3. CVA - HTN+++ - Droop and left arm deficit - Million dollar question.....is it old or new?? - Do we see any aid of daily living to help her with her weak arm? That would make me lean towards an old CVA - Good LOC.... Again, may be an old CVA...not sure I like Kiwimedic idea...a 12-lead. Who knows what this lady K is. Maybe, get the friend to help you out. She may be able to get her to go to the ED. How safe is this lady? Once off the floor can she actually move around and take care of herself? Also, can the friend give more information about the patient? (i.e. the arm and droop) Besides, what ED wouldn't want a 375lbs women in poor health?? Easy to fix and easy to discharge...... =) Cheers... 2 Link to comment Share on other sites More sharing options...
DwayneEMTP Posted May 8, 2010 Share Posted May 8, 2010 (edited) Convince her that there is every chance she is going to die from one or more causes in a short order. And if she doesn't die, she will almost certainly suffer permanent deficits from the symptoms she is exhibiting. Explain to her that if she has one single person in the world that loves her that she is making a very selfish, irresponsible decision. If she continues to refuse, refuse her AMA, leave her with a friend that's been instructed to call you back in a few hours when she's dead or unresponsive, and hit the road. Dwayne Edited to correct grammar only. Edited May 8, 2010 by DwayneEMTP Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 9, 2010 Author Share Posted May 9, 2010 ok for the win Rhabdo was one of her problems DKA was another 5 separate cerebral infarcts, all in different places and all occurring according to the radiologist who read the CT within the last 3 days. She's a train wreck. She is still in the hospital as far as I know. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 9, 2010 Share Posted May 9, 2010 I like Kiwimedic idea... Most people do like my ideas Good scenario Ruff! Link to comment Share on other sites More sharing options...
Chief1C Posted May 9, 2010 Share Posted May 9, 2010 ok for the win Rhabdo was one of her problems DKA was another 5 separate cerebral infarcts, all in different places and all occurring according to the radiologist who read the CT within the last 3 days. She's a train wreck. She is still in the hospital as far as I know. But she did go to the hospital. Link to comment Share on other sites More sharing options...
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