# 62 yr old female(diabetic??)



## unleashedfury (Jan 7, 2014)

Since were getting activity here I'll chime in.

Dispatched to a residence for a 62 yr old female with Diabetic problems. 

Arrived on location to meet her husband in the driveway he states she "hasn't been acting right for 2 days now" This morning she tried to drink the cat milk. and has been talking all kinds of slurred, and cannot be well understood. Has not been compliant with her medications 

Greet Patient she presents Conscious and alert, but cannot answer simple questions appropriately, Initially refuses any treatment and transport offered. but succumbs with the assistance of her husband. Hubby says that she has been going "downhill" she recently lost her mother and has been in a depressive state. 

PMH - IDDM, HTN, Hyperlipidemia, Depression
Medications - Humalog, Simvistatin, Metoprolol, Zoloft, Supplemental vitamins OTC
Allergies - PCN

You assess your patient find 
cannot answer simple questions appropriately, is a little bit abrasive to your assessment interventions. 

BP - 160/94
PR - 102
Resp - 16 non labored, lungs CTA 
ECG - NSR, rate about 100 
Pupils - 4mm,Reactive
BGL - 234mg/dl
Skin - Warm, pale in color, dry

as you are placing your ECG patches, you find some bruising with healing present amongst the torso region and husband states she had took a fall while they were visiting family in another state. Pt. did not get evaluated just shook it off. 

Patient moves to litter with assistance by EMS crew and as your removing her from the residence she starts with a decorticate posturing and begins to have a grand mal seizure. 

Your the medic with a BLS crew transport truck. Closest ED is about 15 minutes away. Closest interventional center is 45 minutes away by ground Aeromedical is available 10ETA once off the ground. 

(I was super shocked to find out the final diagnosis)


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## VFlutter (Jan 7, 2014)

Any focal Neuro deficits? Any signs of recent infarct on EKG? Heart Murmur? 

Any symptoms prior to fall? Head trauma with fall?

Random Zebra guess: Watershed Infarct from Takotsubo cardiomyopathy h34r:


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## unleashedfury (Jan 7, 2014)

Chase said:


> Any focal Neuro deficits? Any signs of recent infarct on EKG?
> 
> Any symptoms prior to fall? Head trauma with fall?
> 
> Random Zebra guess: Watershed Infarct from Takotsubo cardiomyopathy h34r:



LOL that was good 

No symptoms prior to fall, Pt did hit the rear of her head on a hard wood floor when landing. No noted neuro deficits.

ECG looks clean 12 lead shows no abnormalities.


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## VFlutter (Jan 7, 2014)

Sounds like a progressing Subdural hematoma / Cerebral contusion. However since you were surprised by the diagnosis I am guessing it is something else.


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## unleashedfury (Jan 7, 2014)

I was suspecting a Subdural Hematoma or cerebral bleed. 

She was flown to the Regional everything center. Full body CT performed to find the cocunut unremarkable, She was noted with having pancreatitis, and that was the last I heard. She was transferred to a different hospital that she was a retiree from that also offers the same level of care just a different network. And they are a bear to get patient followup info from. You all but need an act of god. 

So as far as I know the pancreatitis was a diagnosis, and I am unsure of anything else.


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