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FireEMT2009

Hmm, this is a nice Greek restaurant...

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You are dispatched to a Greek restaurant for an altered mental status. Upon arrival you find a 58 year old male sitting in a booth with his wife across from him. He is A&O and is following you and acting normally. Wife states that he is suddenly unable to remember things!

 

....And GO!

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What did he eat?

Vitals

Stroke scale?

Glucose

Any medications?

I've heard of a couple of issues with Greek Food, makes you long to travel to the Greek Isles, listen to Yanni and lay out on the Isle of Santorini, er no wait, that's just me.  

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check is orientation with the usual questions, dig deeper into history, stroke scale, meds/illicit drugs, ETOH?

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20 hours ago, Just Plain Ruff said:

What did he eat?

They haven't had a chance to eat yet, they had just gotten their drinks delivered when he started having the issue.

Vitals

B/P- 140/90

Pulse-80

RR- 16

SpO2- 98%

Stroke scale?

Negative

Glucose

118mg/dL

Any medications?

Metoprolol, Lisinopril, and ASA

I've heard of a couple of issues with Greek Food, makes you long to travel to the Greek Isles, listen to Yanni and lay out on the Isle of Santorini, er no wait, that's just me.  

Well played sir!

 

11 hours ago, scubanurse said:

check is orientation with the usual questions, dig deeper into history, stroke scale, meds/illicit drugs, ETOH?

Orientation:

He is alert and oriented, but does not know what day it is, which the wife states is not normal for him.

Hx.

HTN

Medications as listed above, no street drugs or ETOH.

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My suspicion is that it's an early onset of Stroke that could benefit from a stroke center.  I'm not sure what else you can do for this dude in the field for an issue that needs a CT.  Unless you are on one of those fancy shmancy Stroke ambulances that get huge press but then no one remembers they are out there.  

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33 minutes ago, Just Plain Ruff said:

My suspicion is that it's an early onset of Stroke that could benefit from a stroke center.  I'm not sure what else you can do for this dude in the field for an issue that needs a CT.  Unless you are on one of those fancy shmancy Stroke ambulances that get huge press but then no one remembers they are out there.  

So when you start to get some demographics he can give you his SSN, but is unable to give you his date of birth or address. No expressive or affective aphaisa. He also complains that his left eye seems slightly blurrier than normal.

You are approximately 45 minutes away from your nearest stroke center, and you aren't in one of those fancy ambulances.

Once you move him into the ambulance you notice that his speech has started slurring.

 

What other information would you like? Any diagnostic testing you want?

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hey now, am I the only one playing

this guys having a stroke or his sugar is out of whack and your machine is wrong.  

I guess there could be other underlying etiologies but with my limited arsenal of equipment, let's get him tot he stroke center.  How soon can a bird be there versus you driving him to the stroke center.  

A CT is the very best diagnostic tool so is there a hospital closer with an available CT scanner?  

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Haha! The bird has a flight time of 25 minutes one way to you, whereas, there is a regional hospital approximately 20 minutes away emergent, and they do have a CT scanner but they are not a stroke center and will either fly or ground transport the patient out to the same facility that is the stroke facility (also a neurosurgery center) that is 45 minutes away form you currently.

Would you consider using lactate testing on this patient?

His pupils are mismatched, with the left side being about 5mm, and the right being 2mm. The left eye is also sluggish to respond to light.

You also note now that after approximately 10 minutes from arriving on scene, he now has weakend grips in the left hand and weakend strength in foot and also has facial droop on the let side. He also tells you that his eyesight in his left eye is getting much worse.

 

Would you rather go by ground or air, and if by ground, which hospital?

You are approximately 20 minutes since onset time.

If you decided to transport what would your treatment plan be?

Edited by FireEMT2009

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I am not familiar with the lactate testing.  Do tell.  Or link to some info

I'm going to transport now.  I think actually that with the eyesight issue that he's having a hemorrhaigic stroke that might be centered around the area of the optic nerve.  I've had a patient like that,  he stroked out, complained of his vision going in one eye and by the time we got him to the stroke center it was too late to do anything, he herniated in front of the ED staff.  It was a massive bleed and he died shortly after my getting him to the ER.  

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A bit late, but just a couple things to add..

Id also be heading to the nearest facility with neuro. Btw; have we had a good look at his head..ie any recent trauma/falls/head strike? Probably not going to change our management but the reviewing facility would want to know potential med vs trauma aetiology.

Il. As air vs ground, unless he's going to get RSI'd, he poses too much of a risk of dropping his bundle mid flight. Would definitely want an extra pair of hands in the back during the transport 

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