This is a great case sent in my a reader who wishes to remain anonymous. We hope you find it as intriguing as we did!
After clearing up from a routine interfacility transfer, you're dispatched for a 77 year old female who is unresponsive at a local extended care facility. A BLS engine crew is enroute as well and has a few minute lead on your unit.
As you're arriving the engine crew hails you on a tac channel and relays that the patient is unresponsive, but breathing and they have put her on a NRB and are checking her blood glucose level.
You're directed to the room where the engine crew is completing their assessment of the patient. The facility staff states the patient was alert and oriented at 0600 when they did their rounds. However, when they came back at 0900 to give the patient breakfast and her morning medications they found her unresponsive.
Apparently, EMS is called frequently for this patient becoming unresponsive, although she does not know why. She hands you the patient's paperwork as the captain from the engine gives you the patient's vitals:
- GCS: 8 (E2 M2 V4)
- Pulse: 60, weak at the radials
- BP: 118/56
- RR: 16, clear bilateral lung sounds
- SpO2: 82% on room air, 94% on a non-rebreather
- BGL: 102 mg/dL (5.6 mmol/L)
As your partner helps the engine crew move the patient to your stretcher you read over her paperwork:
- PMHx: hypertension, osteoarthritis, renal cysts, urosepsis, advanced parkinson's disease, history of UTIs, dementia, history of plueral effusion, COPD
- Meds: hydrocodone, sorbitol, ferrous sulfate, dulcolak, prednisone, albuterol, ativan, heparin, aspirin, colace, sinemet, synthroid, tylenol, furosemide, potassium chloride, aricept, multi-vitamin, claritin, lactulose
- Allergies: cipro, septra, florinef, bactrim, levaquin, zoloft, gentamicin
A quick physical exam reveals moaning to painful stimuli, pinpoint pupils, whole body tremors, a foley catheter with adequate output amber in color. The remainder of the exam is unremarkable.
In the back of the unit you place the patient on nasal capnography while your partner places the patient on the monitor:
At this point your partner grabs the 12-Lead cable and begins placing electrodes while you acquire an IV.
You're 10 minutes from a local hospital, and 15 minutes from a cardiac center.
- What is our patient's rhythm?
- What does the patient's 12-Lead show?
- What are your treatment priorities?
Leave your answers below!
Looking for the conclusion? 77 year old female: Unresponsive – Discussion.