Unresponsive & breathing

[Rezq304]

when is the last time that she peed?

What does her urine look like? Is she catheterized - if she is and shes in a nursing home then 95% probability is that she has a Urinary Tract infection.

Pt was not cathed. SNF unable to tell anything about last urination. Pt had minimal PO intake for about a week.

[Rezq304]

Forgot to add:

I agree with jwraider on the need for a very detailed head to toe physical exam. She's not much of a historian given her current condition and the handoff info from the facility/crew seems to be less than voluminous. Any interesting findings on the detailed head-to-toe? Since she was an intercept I know you didn't get the chance to look at the surroundings...this makes the physical exam even more important IMHO.

Also, does the monitor have etCO2 monitoring? Maybe we can slip in one of the measuring cannulas? If so how does the waveform and numbers look?

-Trevor

Volunteer truck not equipped with etCO[sub:9b0b66397d]2[/sub:9b0b66397d]. Nothing notable on head to toe other than pale diaphoretic skin. Pupils were equal, but sluggish. Trach mid-line, (-) JVD. Chest unremarkable. Equal bilateral radial pulses corresponding with carotid pulse. Equal pedal pulses. No noted bruising. Positive response on Babinsky test.

[Just Plain Ruff]

the question begs to be asked, just what kind of care is this nursing home providing???

Minimal PO intake over the past week?

Thought she was sleeping?

par for the course

so she hasn't eaten, she has a low grade temp, she has a sugar of less than ideal circumstances, and they have no idea about her urinary output.

so she probably has a uti, she hasn't eaten which probably dropped her sugar even more.

I am going to go with the above.

Or for shits and giggles, she got insulin given to her by mistake.

[whit72]

I am going with Ruff on this one, Hypoglycemic secondary to UTI. I am assuming the diaphoresis is caused by the sugar of 20. The temp of 99 orally really dosent concern me. I wouldn't even consider that a low grade temp.

O2 high flow, monitor her airway, ALS intercept.

So she was hypoglycemic, with a possible UTI, or pneumonia? Am I missing something or do we do this call 1000 times a year.

[Dustdevil]

Or for shits and giggles, she got insulin given to her by mistake.

:shock:

[Just Plain Ruff]

I ran this call about 5 years ago

Called to the nursing home, patient sugar 15

transported to er after giving d50, then find out from family that granny got 12 units of insulin that should have been given to her roommate.

We then had to go back to the same nursing home and get the roommate whos sugar was over 400 due to the mistake.

A fun day.

[Rezq304]

Yeah, nothing really special about this scenario, just wanted to use this avenue to share the quality of the SNF's in this area. Pretty sure Dx of Hypoglycemia secondary to UTI. I'll swing back by the ER today to confirm.

[rocket]

Thanks for the scenario Rezq304! 8)

-Trevor