# Elderly Male sudden collapse/LOC



## Jbray4 (Jun 28, 2011)

Hi everyone, I'm Josh and new to the forum here. I am fairly new EMT-basic, and also in my last year of RN/BSN school. I have worked as a Nurse Tech in a level one trauma center/accredited Chest pain Emergency department for a little over a year. Recently, I also completed my 300+ hour Practicum in the same ED, functioning as an RN (kind of like how a Doc does his residency).

     Well with that said, I'm aware I'm not the most experienced guy around here but I would like your opinions on a scenario this past weekend. I was taking a CCW class this past saturday (12 hours, looong), so I was off-duty. An elderly, probably late 70's, man stood up in the large banquet hall we were in and stated he wasn't feeling well. Of course my eyes perked up and within a second of hearing it, he stumbled and hit the wall, and was lowered safely by his son into a chair. I rushed over and immediately noticed he was pale, diaphoretic, rapid/shallow breathing, and shaky. He said he was a diabetic and felt like he just needed "sugar". I approached him and told him I was an EMT and to tell me how he felt, I felt his radial pulse and it was thready and rapid. Classic Hypglyc. symptoms, and he stated he didn't eat enough breakfast and took insulin this morning. I asked someone to get him a glass of juice, and as I turned to do so, He started having loud snoring respers.
     He went  completely unresponsive, I gave him a tough sternal rub and he didn't respond in the slightest, and immediately opened his airway which stopped the snoring. I had 2 guys quickly help me get him to the floor. I'm sure you've all seen the appearance of someone who is quickly going down hill, and I thought this man was about to breathe his last breathe.       
     After I placed him supine he had a pulse, and as I opened his airway he became responsive, and started talking. I asked him how he felt and sat him up so he could feel comfortable. His breathing improved, and he was still slightly diaphoretic, but he was a&o x3, no droop or slurred speach, and from quick observation he looked stable. I asked if he could swallow fine and I had him drink a glass of OJ. I'd say the LOC lasted 15 seconds maybe. 

This is when EMS arrived. I gave a short report to the Paramedic, and he took over. I stood back and didn't interfere after we moved him to the other room. I am not sure of his exact VS's, but he had good sat's, was tachycardic, 90/60, pale still but not diaphoretic, and his BS was 200...Now I've had my share of hypoglycemic patients in the ED, and of the responsive one's, I haven't ever seen someone's BS spike that quickly and that much from being hypo..Which made me suspect his BP was the cause, a TIA, or he jumped into V-tach or V-fib and converted on his own when I layed him down...Or maybe another arrhythmia typical of a transient LOC like this.

Well EMS decided not to transport him, they didn't even make it a refusal they said "your vitals look alright to me, if you want you can go to the hospital you can, but it's up to you". And of course he didn't "want to go" ha. I calmly reminded the Medic that this man had a complete LOC 20min ago, was unresponsive to painful stimuli, had snoring respers, etc. But idk what the EMS' opinion was, maybe that it was in fact BS and he was fine now? After EMS left the man tried to stay for class, but 30min later felt "not right" and was + for Nausea, dizziness, and when I asked about CP he said he felt some slight "heartburn" like pain. I told his son they need to go to the ED to get this checked out, and he didn't want to call EMS again so he drove his dad himself (ugh lol).

Also...
 I had someone call 911 as soon as I saw the man's appearance initially, and I told them to get an AED as soon as I heard his snoring respers, I wanted to to be prepared if he crashed. Not only did they not have an AED, I had a "CPR certified" hotel employee (she was of no where to help during the actual event ofcourse) rather arrogantly how I shouldn't have put him on his back, and should have put him on his side. I politely stated that in my training, we only do that with an unconscious, but stable patient. This man needed his airway maintained, and assessed (pulse check, etc.) while supine to see if CPR was needed. I probably would have put him in recovery if he stayed unconscious, but was stable...

I talked to a few Emergency Physicians I work with and they agreed he should have been transported..What do you guys think? Did I respond alright? Should they have transported him?


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## Anjel (Jun 28, 2011)

As for you personally....

Good job. I think you did great. You did everything you possibly could, and did a great job with not panicing. 

As for what the medics thought I have no idea. Without being there and seeing what they did assessment wise, and what made them determine he didn't need to go. 

Because his BGL was 200 when they checked it, it makes me think that wasn't the problem and could of possibly been cardiac related. But there are just too many variables that I don't wanna make a guess.


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## foxfire (Jun 28, 2011)

First of all, welcome to the forum.
And now about the incident.  I think you did great. Without the medics assessment findings, it is impossible to make a yay or nay about the pts condition.


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## abckidsmom (Jun 28, 2011)

I think its pretty easy to make a decision just based on the history.  Old people with unexplained syncope go to the hospital, period.  Fishing for refusals makes me so angry.  One of the other medic units in the county is 4 for 4 today with non-transports...the guys are cheering for them and jealous of their excellent record.

I'm a little worried for their next patient, when they'll be worried more about breaking their streak than providing good care to the patient.


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## shfd739 (Jun 28, 2011)

abckidsmom said:


> I think its pretty easy to make a decision just based on the history.  Old people with unexplained syncope go to the hospital, period.  Fishing for refusals makes me so angry.  One of the other medic units in the county is 4 for 4 today with non-transports...the guys are cheering for them and jealous of their excellent record.
> 
> I'm a little worried for their next patient, when they'll be worried more about breaking their streak than providing good care to the patient.



^^^^^ What she said. You did everything right. The crew should have transported this guy. 

I hate the medics that go looking for refusals or talk people out of it. 


Sent from my electronic overbearing life controller


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