OCTOBER 2015 CASE STUDY

You and your partner are working for an ALS service and are called at 0200 to a private residence for approx. a 45 YOM. The pt’s wife meets you at the door and advises you that the pt was “shaking in bed” for about five minutes, and is now not waking up. The pt is lying supine in bed w/no obvious trauma noted. He is a GCS of 5; occasionally moans and movement w/deep painful stimuli. Pt is incontinent of bowel and urine; no recent drug use or ETOH consumption reported. He was reported last seen normal at approx. 1900 the evening before with no complaints.

HISTORY

  • Cocaine usage
  • HTN

MEDICATIONS

Prescribed Lisinopril; has not taken it in months

ASSESSMENT

  • Eyes: Dilated bilaterally
  • Skin: Cool, pale, moist
  • Resp: Irregular, shallow, and bradypneic @4-6bpm
  • Pulse: Bounding, regular, rate of 64
  • BP: 212/124
  • BGL: 118mg/dl
  • SpO2: 90% R/A
  • EKG: Reveals no ST abnormalities/ectopy

You are 10 mins away from a community hospital and 20 mins away from a PCI/Level II Trauma Center.

What are your priorities? What facility would you take him to?