# 75 year old female- "Acting Strange"



## musicislife (May 2, 2012)

Initial Assessment: Responds to verbal stimuli. Alert and Oriented times 0 (no idea who she is, what month it is, and where she is.) Airway clear. Breathing Clear. Pluse is weak and thready. Notice a fruity breath odor. Stay and play here. 

No family to collect SAMPLE

Administer glucose 

Check Vitals: 110/76, HR: 80 Respiration: 15 breaths/min

Take her out on the Stair Chair

Check vitals every 10min an monitor any changes in responsiveness en route 

What would You do in this fictitious scenario?


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## Aidey (May 2, 2012)

Not give glucose.

Also, if she is so out of it, who called 911?

Edit: And you don't need a family to collect a sample history. Look around. Meds are usually in the kitchen or bathroom. Check the fridge for insulin or a vial or life. Home glucose and BP monitors have memory functions you can use to see how often they are used and what the numbers are.


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## Maine iac (May 2, 2012)

Not give glucose without knowing what her blood sugar level was. What you were possibly smelling were ketones, and most likely she is in some form of hyperglycemia.

Or she has been drinking something fruity and alcoholic.

My treatment probably wouldn't differ too much, but I'd like to know where I find this person. Park bench? House? Nursing home? Sidewalk?

See if she has any medical alert tags, and check her purse, but most likely she'll get the standard IV, monitor, blood sugar level checked and go from there.



Why did you give glucose?


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## musicislife (May 2, 2012)

yea i just re read the book..says fruity breath is a sign of Diabetic Coma not Insulin Shock..is that why you wouldn't give glucose?

she is in the supermarket. She was repeating how she wanted a cookie, and stumbling. Her 5 yr old grandson called 911.


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## Aidey (May 2, 2012)

Diabetic coma and insulin shock? What on earth book are you reading? 

Someone please tell me those are still not standard terms used in textbooks today?


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## musicislife (May 2, 2012)

I am a first responder. They have to dumb stuff down in that book. Thanks to a previous post i know know hyperglycemia is high blood glucose and hypoglycemia is low blood glucose.


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## RustyShackleford (May 2, 2012)

I know you are attempting to learn but the fact that you explained that you just learned what hypoglycemia and hyperglycemia are indicates that you are quite new at this....I mean this in the nicest way possible, but might I suggest that before writing out fictitious scenarios maybe get yourself a good patho book of some kind or maybe even start learning simple ecg skills that will be more useful in the future rather than scenarios.


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## mycrofft (May 2, 2012)

I read Brady's MFR text. It is a little confusing, but not "dumbed down", it is a lower level of medical response and designed to be that way. Share your reasoning behind your treatment.

5 y/o called 911?


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## Medic Tim (May 2, 2012)

as a first responder why "stay and play"

what are you going to do that you cant do en route to definitive care or intercept?


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## musicislife (May 2, 2012)

By stay and play i mean he isnt a rapid transport


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## Sasha (May 2, 2012)

musicislife said:


> By stay and play i mean he isnt a rapid transport



AMS is something i would hurry along. 

But yeah don't give oral glucose if you're smelling ketones.

Ketones means the body is using fat for energy instead of sugar. Don't add more sugar.


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## Handsome Robb (May 2, 2012)

Sasha said:


> AMS is something i would hurry along.



This. 

I've seen a few DKA cases now and not once have I smelled ketones. They all smelled too bad and the glucometers where I work have a ketone reading so I'm not going out of my way to smell their breath. Plus prehospitally there isn't anything to do differently if it's HHNK vs. DKA.


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## Medic Tim (May 2, 2012)

musicislife said:


> By stay and play i mean he isnt a rapid transport



I wouldn't waste to much time on scene with this call

I agree this isn't a rapid transport


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## Aidey (May 2, 2012)

One of the ED docs told me that not everyone can smell ketones, kind of like cyanide.


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## Medic Tim (May 2, 2012)

Aidey said:


> One of the ED docs told me that not everyone can smell ketones, kind of like cyanide.



one of my old partners could not smell acetone/ketones


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## Achilles (May 3, 2012)

If she was in the supermarket, why'd you take her out in a stair chair?


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## Handsome Robb (May 3, 2012)

Medic Tim said:


> one of my old partners could not smell acetone/ketones



Maybe that's my problem. 

To go farther on stay and play in this scenario, I'm not doing anything in the store. Get a quick room air Sp02, toss her on some Os if it's appropriate, correct an airway issue if I have to with a basic airway adjunct then move to the truck and do everything in there. Partner does the line, hangs a bag and gets a sugar for me while I do a 12-lead then move along to the hospital routine unless it's a hypoglycemic issue that I can fix on the spot.


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## Veneficus (May 3, 2012)

Aidey said:


> One of the ED docs told me that not everyone can smell ketones, kind of like cyanide.



I cannot smell ketones.


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## Smash (May 3, 2012)

I can smell malaena.  I wish I couldn't.


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## NomadicMedic (May 3, 2012)

Smash said:


> I can smell malaena.  I wish I couldn't.



I can smell UTI.


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## Sasha (May 3, 2012)

I can smell CDiff. 

Seriously it smells different then regular poop.


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## DrParasite (May 3, 2012)

Sasha said:


> I can smell CDiff.
> 
> Seriously it smells different then regular poop.


I go out of my way to not smell poop, whether it be CDiff or regular poop.


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## Sasha (May 3, 2012)

DrParasite said:


> I go out of my way to not smell poop, whether it be CDiff or regular poop.



The smell often dominates the room.


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## abckidsmom (May 3, 2012)

Sasha said:


> I can smell CDiff.
> 
> Seriously it smells different then regular poop.



Rotavirus does too, but I also can't smell ketones. 

I have a very terrible sense of smell.


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## mycrofft (May 3, 2012)

Perhaps our OP does not actually transport? His other action scenario also terminates with removal by stairchair.


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## Remeber343 (May 3, 2012)

Pssh, stair chair?  FIREFIGHTER CARRY. Cause' nothin' is more badass then that


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## RustyShackleford (May 3, 2012)

Gotta use firefighters for something....


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## Frozennoodle (May 12, 2012)

musicislife said:


> Initial Assessment: Responds to verbal stimuli. Alert and Oriented times 0 (no idea who she is, what month it is, and where she is.) Airway clear. Breathing Clear. Pluse is weak and thready. Notice a fruity breath odor. Stay and play here.
> 
> No family to collect SAMPLE
> 
> ...



"What went wrong" by Eminem

Confused old betty,
Pulse is weak,
feelin' thready,
no vomit on her sweater it's soft and heavy, got no sample hx
medic's nervous but on the surface he looks calm and ready
to drop balms, but he keeps on forgetting
what the med director wrote down, the monitor grows so loud
she opens her mouth, and it smells like fruit comes pourin out
hes chokin how? everybody's jokin now
givin' glucose to a dka? you're over POW
up goes the cbg, now her gcs is 3
oh there goes the medic he choked 
QA is mad and they won't give up that
easy, no
med director wont have it, medic's got his back to the ropes
should have listened to ROPE (region one protocol effort)
no more license he's broke


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