This case comes from a reader who wishes to remain anonymous, as always details have been changed to protect patient and provider privacy.
You're working an overtime shift at a college football game on a hot Saturday in August, when a man flags down your crew. You head on over and are directed into one of the stadium tunnels to a female laying on the ground with bystanders pouring cold water onto her.
One of her friends reports she felt hot and dizzy while watching the game and came into the tunnel to, "cool off." She then said she felt faint and her legs gave out from underneath her and she fell to the ground.
You introduce yourself and ask the patient how she feels, however, while her eyes track you appropriately she is very lethargic and slow to answer. Her friends are unaware of any medical problems your patient may have.
Your partner obtains a set of vitals while you place the patient on the monitor.
- LOC: alert to verbal (GCS E3 V5 M6)
- Pulse: weak radials at 50 bpm
- BP: 80/50
- RR: 14, shallow, clear lung sounds
- SpO2: 92% r/a
- BGL: 68 mg/dL (3.8 mmol/L)
Your event jump bag lacks all but basic trauma and IV supplies so you request an ALS unit meet you on location. Your partner establishes an IV and hangs a bag of fluids. The rhythm strip prints out.
Noting a difference in rate, you ask your partner to recheck her radial pulses. He confirms they are now at 120/min and weak; you direct him to place a BP cuff around the liter bag and to work on a second line.
Your partner asks, "should we give her anything for her blood sugar?"
A quick history from the patient reveals no major medical problems, takes no medications, has no allergies, and she denies any history of diabetes. You acquire a 12-Lead ECG as the ALS unit checks on scene.
Multiple rhythm changes are noted on the monitor and a long strip is printed.
The ALS crew asks you for a report as you help place her on their stretcher.
- What is your diagnosis? What are your next steps?
- What does the first rhythm strip show?
- What does the 12-Lead show?
- What does the long rhythm strip show?