# 90yrs Male, ? stroke



## Melclin (Jun 20, 2011)

This is a job I did recently and I thought it highlighted quite nicely, the way our system can work well, so I thought I'd post it. I'm always banging on about education and moving away from the idea that EMS just "rush people to hospital", so I thought I'd give you all an example of a job that I think went pretty well. 

About 2:30 in the afternoon of a cool and overcast day you receive a request from nursing staff at a retirement village to see a 90 year old male, ?stroke.

You are met at the door by an older gentleman who turns out to be your pt. 

*Event Hx*
Pt woke at 2am last night and noticed tingling/numbness in R&L forearms, little fingers, L leg weakness and a mild headache. He thought it was simply a case of having slept awkwardly and went back to bed. Symptoms persisted when he woke at 8am. Pt consulted retirement village nurse. Ambulance called, ?stroke.

Due to some shockingly bad resourcing outside the control of the ambulance service, we arrived at 3pm about 5 hours after the call which is totally unacceptable but that's another story. 

*O/E* 
Pt reports symptoms mostly resolved with exception of continuing numbness in his fingers. Pt otherwise asymptomatic other than some mild anxiety. 

BP: 195/110, RR: 16 HR: 76, GCS 15, Temp 36.0, Sp02: 97

PEARL, nil facial droop/altered sensation or movement, nil visual disturbances, normal speech and hearing. Normal sensation/movement/strength in limbs with the exceptions of some mild numbness in fingers. Behaviour normal per pt's wife. 

Heart and lung auscultation is unremarkable. Didn't so an abdominal exam.

Hands and feet are very cold. Pedal pulses weak. 

ECG reveals atrial fibrillation with the occasional uni-focal VE.

*Meds*
Irbesartan
Rosuvastatin

*Hx*
-August 2009, pt presented to ED via ambulance with symptomatic A.flutter, pacemaker inserted.
-Hypertension (pt has been increasingly hypertensive in past few months).
-Hypercholesterolaemia 
Recently in good physical health, but when asked specifically, pt reports getting tired quite easily when doing the shopping. Pt also reports increasingly depressed mood regarding his wife's declining health. 

Pt reports normal oral intake, bowel movements and micturition.

Pt lives with wife who has been quite frail and prone to falls since a stroke 6 months ago. 

Feel free to ask further questions (I've had a couple of beers, I'm sure I've forgotten something ^_^ ), or suggest ways you might gain further information.

*Now I'm interested in a few things.* I'd like to hear how you would manage this job in your system (including what sort of unit/how many people sent, on what priority etc), then how you would LIKE to manage it (if different from how you WOULD manage it due to systemic considerations). Would you transport/where would you transport. What are all your considerations in this case? After I get a few people answering, I'll post what we did (not to _compete_ personally, but to compare how things are done here versus in your system), and I'd like your learned opinions on our management of this job. Like I said, I felt we did some good work here, but I'm very open to criticism


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## MrBrown (Jun 20, 2011)

Brown reckons this bloke has had a TIA and needs to be put on the stair chair and taken to the place which attracts medical school graduates for the purposes of employment so they can have a gorp at his noggin with the expensive machines.

One ambulance, Intensive Care Paramedic not required.


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