Jump to content
BushyFromOz

70 y/o M, unwitnessed collapse

Recommended Posts

Your called to a 70 year old male who was found collapsed at the end of his driveway. His wife says that he left the loungeroom 20 minutes ago to shut the gate and did not return, when she went to look for him she found him laying on the concrete in an altered conscious state.

Inital obs are..

GCS 6

B/P 130/90

HR 70, BSR

Temp 36.8

BSL 5.8

RR 18

what else would you like to know?

Share this post


Link to post
Share on other sites

BSR?

BSL I am assuming is blood sugar level, but at 5.8 ? Do our glucometers in the states use different measurements?

Share this post


Link to post
Share on other sites

BSR?

BSL I am assuming is blood sugar level, but at 5.8 ? Do our glucometers in the states use different measurements?

Yes. Glucometers in the US measure differently than Canada, UK, most of Europe and Down Under. In the US we measure in mg/dL. The aforementioned locations measure in millimoles/liter or (mmol/l).

To convert mmol/l of glucose to mg/dl, multiply by 18.

To convert mg/dl of glucose to mmol/l, divide by 18 or multiply by 0.055.

So the BGL of 5.8 mmol/l is 105.

Hope this helps.

edit: forgot volume of measurement when referencing mmol/l

Edited by paramedicmike

Share this post


Link to post
Share on other sites

Lets have a squiz at his ticker?

Does the wife have any medical hx to give us?

No evidence of trauma - i.e. wasn't traded for the mailbox by a bunch of baseball bat carrying teens or no Koala bear marks?

I am thinking either cardiac e.g. bradycardia/hypotension, metabolic e.g. hypoglycaemia/DKA or neurogenic e.g. stroke/TIA

Share this post


Link to post
Share on other sites

Your called to a 70 year old male who was found collapsed at the end of his driveway. His wife says that he left the loungeroom 20 minutes ago to shut the gate and did not return, when she went to look for him she found him laying on the concrete in an altered conscious state.

Inital obs are..

GCS 6

B/P 130/90

HR 70, BSR

Temp 36.8

BSL 5.8

RR 18

what else would you like to know?

Stroke exam? Kiwi already asked about the ticker

Any recent history of bouts of confusion or showing signs of mental status changes on a increasing basis?

What did he eat today?

any chance he got into something outside like a allergen or something ingested?

If he's in Australia any evidence of spider bite or snake/scorpion exposure?

Share this post


Link to post
Share on other sites

Hello,

See well 20 minutes ago.

Now, he has a GCS 6/15 with slight hypertension (130/90). I am think a CNS issue.

Lets get some more information:

Pupils?

A break down of the GCS? Eye score? Verbal? Motor?

See what the EKG shows?

More or less.....what has been posted already.

Cheers

Share this post


Link to post
Share on other sites

ok, some answers for you all.

BSR should be NSR (normal sinnus rhythm) Fat fingers, cant type and apparently i cant proof read either ;)

Hx- hypertension, paroxsysmal Af, type2 diabetes, had a DVT a few years back, depression and being treated for a chest infection

ECG = Sinus Rhythm in 1,2,3 AVF, AVL, AVR and V1

GCS = E1, V2, M3

Pupils = 2mm, very sluggish to respond.

Temp = is 35.5 celcius

No evidence of trauma or drop bear marks kiwi

Ate a roast chicken sandwich for lunch.

No evidence of inflammatory response

Wife states that he suffers from depression, but has gotten quite a bit worse in the past few weeks, states he has been becoming increasingly withdrawn, often muttering under his breath and quick to temper.

Share this post


Link to post
Share on other sites

ok, some answers for you all.

BSR should be NSR (normal sinnus rhythm) Fat fingers, cant type and apparently i cant proof read either ;)

Hx- hypertension, paroxsysmal Af, type2 diabetes, had a DVT a few years back, depression and being treated for a chest infection

ECG = Sinus Rhythm in 1,2,3 AVF, AVL, AVR and V1

GCS = E1, V2, M3

Pupils = 2mm, very sluggish to respond.

Temp = is 35.5 celcius

No evidence of trauma or drop bear marks kiwi

Ate a roast chicken sandwich for lunch.

No evidence of inflammatory response

Wife states that he suffers from depression, but has gotten quite a bit worse in the past few weeks, states he has been becoming increasingly withdrawn, often muttering under his breath and quick to temper.

So what are his psych meds he's taking? Does his wife take psych meds also that he might have gotten to also.

What other medications do they both take that an overdose could give these types of symptoms.

Normally in my experience on multiple drug overdoses, if the medication is in the house the person adds it to their list of stuff to put in their mouths.

So IV, Oxygen, monitor. Transport

Give narcan if protocols allow.

How far is the hospital?

Share this post


Link to post
Share on other sites

ok, some answers for you all.

BSR should be NSR (normal sinnus rhythm) Fat fingers, cant type and apparently i cant proof read either ;)

Hx- hypertension, paroxsysmal Af, type2 diabetes, had a DVT a few years back, depression and being treated for a chest infection

ECG = Sinus Rhythm in 1,2,3 AVF, AVL, AVR and V1

GCS = E1, V2, M3

Pupils = 2mm, very sluggish to respond.

Temp = is 35.5 celcius

No evidence of trauma or drop bear marks kiwi

Ate a roast chicken sandwich for lunch.

No evidence of inflammatory response

Wife states that he suffers from depression, but has gotten quite a bit worse in the past few weeks, states he has been becoming increasingly withdrawn, often muttering under his breath and quick to temper.

Ok a few things I noticed...

Temp down 1.3 C what is the weather outside?

Also the GCS has droped from 6 to 5. I can't tube but ALS would be on this one (less then 8 intubate LOL)

Bushy what was the time between the inital assesment and these current findings? Just so I can figure out how fast he is decompinsating.

Being he has NSR I am not thinking cardiac. 130/90 w/ a hx of hypertension isn't too concerning at this point. You say he ate for lunch, when was that from this time? Did he take his insulin properly or is he on a pump?

The hx of depression is a flag for me especially with the eyes, could he have overdosed? did he have an interaction with any other meds? Being she stated his syptoms have gotten worse recently and the only new hx would be the infection are we looking at interaction vs overdose?

I will wait for some of those answers.

Edited by UGLyEMT
  • Like 1

Share this post


Link to post
Share on other sites

Hello,

A rapid decline in LOC, abnormal flexion, dropping body temperature makes me lean towards a CNS cause.

Such as a SAH, AVM, or maybe a brain tumor that has bleed or become symptomatic. An expanding tumor (frontal) could explain the personality changes and quick temper.

Cheers

Share this post


Link to post
Share on other sites

×
×
  • Create New...