fireflymedic Posted August 27, 2008 Posted August 27, 2008 You are dispatched to a 42 year old male for symptoms of confusion and agitation. On arrival, you find the patient sweaty and nervously sitting on the couch. The patient's sister states he has been like this for the last hour and has also been vomiting. When you attempt to stand the patient to move him to the stretcher, you notice he is quite uncoordinated and feels quite warm. On taking vitals they are as follows: BP : 104/64 Pulse : 122 Resp : 12 Temp : 101.4 PMHX : depression, paraplegic, foley catheter present, diabetes Meds: zoloft, glucophage Allergies : penicillin What else would you like to know and what's going on with this fellow?
Just Plain Ruff Posted August 27, 2008 Posted August 27, 2008 D-stick immediately Temperature EKG 12 lead Look around and see if the medications he is taking are empty or if they don't look like they have been taken. I'm suspecting initially infection resulting in blood sugar issues. Could also be a CVA or bleed of some sort MI is in the back of my head too.
Canadian Caesar Posted August 28, 2008 Posted August 28, 2008 Same as above and also query any history of thyroid problems?
azemtjunkie79 Posted August 28, 2008 Posted August 28, 2008 Ok off the wall here but he is a paraplegic does he have any ulcers that might have become infected ?
toutdoors Posted August 28, 2008 Posted August 28, 2008 Get blood sugar, keep cardiac in back of mind. For now
ambulancetramp Posted August 28, 2008 Posted August 28, 2008 I would like to know the answers to the above questions. I am currently leaning towards some kind of infection like uti, or maybe diabetic issue. I would like to know lung sounds and if there has been any sputum and if so what color etc.
snakemedic Posted August 28, 2008 Posted August 28, 2008 He's a paraplegic and has a foley catheter, why are we standing him up and then mentioning he is quite uncoordinated. Apart from that, what is the color of his urine, when was it last changed, when was it last drained and how much, what time of the day is it, how long a paraplegic. How much has he vomited up?
Just Plain Ruff Posted August 28, 2008 Posted August 28, 2008 He's a paraplegic and has a foley catheter, why are we standing him up and then mentioning he is quite uncoordinated. Apart from that, what is the color of his urine, when was it last changed, when was it last drained and how much, what time of the day is it, how long a paraplegic. How much has he vomited up? HOLY CRAP, I didn't even catch that. No wonder why he got shaky. you try to stand on two legs that haven't worked for years.
firedoc5 Posted August 28, 2008 Posted August 28, 2008 I'm agreeing with the others on possible UTI. How has his output been in the last couple of days? At anytime was his catheter bag completely full and was delayed to be empty for some reason? What did he eat or drink last? How much has he drank in the last couple of days? Any ETOH? Any flank pain or abd. cramps? What is the cause of his paraplegia?
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