chbare Posted July 11, 2007 Share Posted July 11, 2007 You are called to provide transport of a patient with altered mental status from a small rural hospital to a hospital with additional resources. The patient's diagnosis is "altered mental status." Take if from here. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted July 12, 2007 Share Posted July 12, 2007 I'd like to take report from the hospital to find out what's going on, or at least their opinion of what's going on. Link to comment Share on other sites More sharing options...
EMSGeek Posted July 12, 2007 Share Posted July 12, 2007 Did the hospital do any tests? How about a blood glucose level? Run through the AEIOU-TIPS pneumonic to try and determine a cause for the AMS. How long has the pt been in the hospital? How did they get to the hospital? Has their level of AMS changed? What have their actions been while altered? (Is the scene safe?) Any medical history? What do I see when I see the patient? What is their posture, appearance, demeanor, etc? Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 12, 2007 Share Posted July 12, 2007 You are called to provide transport of a patient with altered mental status from a small rural hospital to a hospital with additional resources. The patient's diagnosis is "altered mental status."I'll begin with the report I receive from the nurse, as I usually get this before I even see the patient. Link to comment Share on other sites More sharing options...
chbare Posted July 12, 2007 Author Share Posted July 12, 2007 The ER is a zoo and the patients nurse is a travel nurse that just came on shift. She has no idea what is going on with the patient and the patients prior nurse is long gone. The only report you receive is that the patient was discharged home yesterday with a dx of gastroenteritis and was brought back in by her husband because she was not feeling well. The nurse takes off into another room with the other ER staff and the ER doc. It looks like they are working on a bad patient and are preparing to RSI. There is a jumbled stack of copied paperwork in the patients room. The BGL performed today was noted as 288mg/dl. Initial presentation and assessment: Lethargic 56 year old female patient with a patent airway supine in bed. Neuro: Lethargic, moans with verbal stimuli, opens eyes and moves all extremities with verbal command, only answers questions with simple yes no answers. HEENT: PERRL, EOM's intact, atraumatic unremarkable exam. CX: Unremarkable atraumatic exam, lung sounds clear with equal bilat excursion. Cardiac: No gallop, murmur, or muffled tones noted, sinus tachycardia at 103 on the monitor without ectopy. Abd: Unremarkable atraumatic exam, soft and non tender to palp times 4. Pelvis: Unremarkable atraumatic exam. Back: Unremarkable atraumatic exam. Extremities: Unremarkable atraumatic exam, cap refill 2-3 seconds distally, moves all extremities, patent 18 ga IV to right FA with NS at KVO. Skin: Pale, warm, non-diaphoretic. History (HPI) from the husband: Patient was sick for a couple of days with nausea and vomiting. Went to ER and was worked up. Admitted with "gut infection." The following day she was feeling a little better and worked up again. She was sent home that night and started to "act strange" and was taken back to the ER today. Past Medical History from the husband: NIDDM, HTN, Elevated lipids, obesity, and GERD. Medications per husband: "Sugar pills," "blood pressure pills," "cholesterol pills," and "stomach pills." Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted July 12, 2007 Share Posted July 12, 2007 I'd refuse transport as I have a sick pt with no information. This is a setup for badness. I realize that this is just a scenario so we'll play along. Since we have the chart, let's thumb through and see what has been done. Maybe that will help us figure out what is going on. Link to comment Share on other sites More sharing options...
chbare Posted July 12, 2007 Author Share Posted July 12, 2007 ERDoc, I agree. This is simply a way of making everybody dig a little deeper in their thinking and history gathering. From the chart you note that she was worked up in the ER and also had CT scans of her chest, abd, and pelvis. From the notes, nothing significant was noted, so she was admitted. The following day, she was feeling a little better and had repeat CT scans of her chest, abd, and pelvis with negative findings. She was discharged that HS and continue on her home meds. The following day, her husband brought her back into the ER with complaints of lethargy. She has had lab work up and IV therapy only for her current ER course. It looks like there are a few old progress notes from her primary care provider with past history and medications. Take care, chbare. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 12, 2007 Share Posted July 12, 2007 What's her current white cell count? How about her urine test? We know her sugar level I too would not take this person until someone on duty can give me a better report. Link to comment Share on other sites More sharing options...
chbare Posted July 12, 2007 Author Share Posted July 12, 2007 No UA, she has not given a sample. The WBC is 12.8. Take care, chbare. Link to comment Share on other sites More sharing options...
EMSGeek Posted July 12, 2007 Share Posted July 12, 2007 Could you interpret the WBC for me? A quick google search shows me that a normal reading is "4,500-10,000 white blood cells/mcL (cells per microliter)". How does the figure you gave relate? Sorry about the dumb question. What are her vitals? When answering questions is she searching for the answers? Why only one word answers? Any joint pain, rashes, or dizziness? Regarding the UA...has she not been asked to urinate? has she been unable/unwilling to urinate? does she have a decreased need to urinate? Link to comment Share on other sites More sharing options...
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