DwayneEMTP Posted October 14, 2012 Posted October 14, 2012 You are dispatched to the local state run nursing home at midnight. Dispatch states that they have a 94 year old female stroke victim that needs to be transported to the ER. They are requesting no fire response, and no lights or sirens from the ambulance. You arrive on scene emergent, though quietly, (Cause you don't really like the nursing home telling you how to respond), are escorted to a room far in the back of the facility. While the nurse escorts you back she explains that the patien has sever right sided facial droop and slurred speech, that she fell out of bed while trying to go to the restroom causing the discovery of these issues. She did no further neurologic testing. Patient is on no significant medications and has no significant medical history other than walking the planet for the last 96 years. There you find what appears to be a very dignified looking elderly lady sitting up in her bed looking like she was recentely awakened... What would you like to know? 1
Bieber Posted October 15, 2012 Posted October 15, 2012 Time last seen normal? Was the patient like this before they went to bed? I also want to ask the patient when this all started... if they woke up with the symptoms or if they woke up and THEN acquired the symptoms, or if they had them at all before? What time did the patient go to bed? Let's also do a stroke scale, check her head for any injuries related to the fall, and get a set of vital signs (HR, BP, SpO2 and BGL). Can we also get a PMH, meds, and allergies? Thanks.
DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 Pt appears normal to me now. No noticeable facial droop, stroke scale negative. Pt claims that she had to pee, went to get out of bed, hooked her foot in a blanket and sat down hard on her bottom. She states to having no pain from the fall, there are no apparent injured visible or to palp on her rear, hands, elbows. Her only complaint is that it's almost 1:00 am and she would like to be allowed to go back to sleep. She needs no assistance other than to be left alone. HR 86, BP 146/88, SPO2 96% r/a, BGL 97. Do you mean a better PMH/MEDS than no significant history or medications? :-) NKDA.
Bieber Posted October 15, 2012 Posted October 15, 2012 Pt appears normal to me now. No noticeable facial droop, stroke scale negative. Pt claims that she had to pee, went to get out of bed, hooked her foot in a blanket and sat down hard on her bottom. She states to having no pain from the fall, there are no apparent injured visible or to palp on her rear, hands, elbows. Her only complaint is that it's almost 1:00 am and she would like to be allowed to go back to sleep. She needs no assistance other than to be left alone. Hm. Let's get a better description from staff on what they saw. HR 86, BP 146/88, SPO2 96% r/a, BGL 97. Not terrible. A little hypertensive. Do you mean a better PMH/MEDS than no significant history or medications? :-) NKDA. Doh! Reading fail. So basically what we've got so far is a possible TIA. Depending on what staff describe and how credible we can consider their findings (considering they did no further assessment and the possibility for environmental issues having skewed their initial findings (i.e. lighting, etc)) I'd recommend further assessment at the hospital.
Arctickat Posted October 15, 2012 Posted October 15, 2012 How many days ago did she fall outta the bed? Is there a 99y/o male hiding under the bed c/o chest pain? Thanks for the tip curiosity.
DwayneEMTP Posted October 15, 2012 Author Posted October 15, 2012 Staff claims that when the patient's bed alarm activated that she came in and found the patient getting herself up off of the floor, that she had severe right sided facial droop, severely slurred speech. She's starting to get really pissed off that you're asking all of these questions after she's already told you to take her to the hospital. The patient denies that these symptoms ever existed.
Bieber Posted October 15, 2012 Posted October 15, 2012 To the staff: "Thank you for your help, we'll take it from here. Please give us a moment alone with the patient." Then let's give them a look to please gtfo. To the patient: "Did you have any problems at all tonight? Can you think of any reason why they would think that you were having these symptoms? Also can you tell me your name, where you're at, the date and approximate time?"
Arctickat Posted October 15, 2012 Posted October 15, 2012 Errrrr, patient was getting herself up off the floor with right side hemiparesis? Most 96 year olds I know can't even get themselves off the floor when they're feeling normal. I smell a red herring.
Recommended Posts