JULY 2015 CASE STUDY

You and your partner are dispatched to a welfare check at a senior living community. As you arrive on scene, you are greeted by police officers attempting to make contact with the resident; they report that the patient is talking through the door, but will not follow commands, and is confused when asked to unlock the door. The patient’s son is also on scene attempting to make contact with the patient via telephone. The son reports that he spoke with the patient approximately an hour and a half ago, and noted that the patient sounded confused and “not like himself”. After fifteen minutes of coaching, the patient is able to crawl to the door and unlock it. Upon entry, you note that the condo is swelteringly hot with no operational air conditioning or fans going. You and your partner detect the smell of alcohol, but cannot find any open containers in the condo. The patient’s son volunteers that patient in his mid-to-late fifties and was recently hospitalized about a month prior for “heart problems”; after a bit of digging you find the following.

HISTORY

  • Atrial fibrillation
  • Previous AMI with stent placement
  • CHF
  • HTN
  • Chronic Back Pain

ALLERGIES

  • Cardizem
  • Codeine
  • Penicillin

MEDICATIONS 

  • Metoprolol
  • Coumadin
  • Digoxin
  • Furosemide

The patient’s son volunteers that the last time the patient was acting appropriately was 24 hours ago. Rapid assessment reveals no obvious trauma. The patient is a GCS of 13; he is awake and alert, but when asked his name, he gives his address; when asked who the president, he states “Reagan”. Patient repetitively asks where he is at despite having living at the condo for five years. Patient is seated upright on his couch, naked. Respirations are between 16-20 and unlabored. Lung sounds are clear and equal in all fields with equal chest rise and fall. Blood pressure is 164/104 with a heart rate of 156/irregular. Pupils are PERRL. Equal facial symmetry noted bilaterally and no slurring of speech noted. What do you do? Would your treatment change depending on if you were working on a rural rig vs. an urban rig that was closer to definitive care?

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