Call came in as AMS/Combative, crashed en route to ER?

chunkypeaches

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A few months ago a call came in for an (appx) 80 y/o male patient to be taken to the ER due to altered mental status. The call came from a nursing home. Pt reported to have backhanded another resident and thrown a metal folding chair at a nurse. upon arrival the man was sitting down eating his lunch like nothing had happened. RN relays to us that he is demented. Pt gets on stretcher on his own and even begins to buckle himself in! during transport he and I have a normal conversation, he doesn't complain of any injury or illness, no difficulty breathing. All of his vitals are within normal ranges and he even answers questions appropriately. He is AXOX4. It was a short transport, only about 7 mins, and we're talking about christmas coming within the week, we arrive at the ER. I turn to the doors on the truck and its raining and really cold, my partner opens the doors and i tell the Pt "get ready mr.xxx it's pretty chilly out!" and i get no response i say his name again and give a sternum rub, no response. we take him inside and hand him over to ER staff. We had a call pending so all i could do was give a report and leave. Next day at ER again his nurse tells us he was intubated within 5 minutes of being there and died later that evening. Any thoughts?
 

NomadicMedic

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From the paucity of information you've given us, that guess was as good as any other. Also, you've apparently never watched House.

If you want us to play guessing games as to why your patient died, provide clinical information. Actual vital signs. Physical presentation. History. Meds.

Ya know... that stuff that we use to figure out what's wrong.
 
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chunkypeaches

chunkypeaches

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Based on what you said Crohn's disease is ruled out which means Lupus is the next logical choice.
Good point thanks! I'm still pretty new I this. I've only been working on an ambulance for about 6/7 months now so I'll take any info you guys have! There's still plenty of stuff out there that leaves me scratching my head.
 
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chunkypeaches

chunkypeaches

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From the paucity of information you've given us, that guess was as good as any other. Also, you've apparently never watched House.

If you want us to play guessing games as to why your patient died, provide clinical information. Actual vital signs. Physical presentation. History. Meds.

Ya know... that stuff that we use to figure out what's wrong.
Gotcha sorry my post seemed a bit dry in the way of more detailed info. This was a few months ago so the number are foggy for me. But I can say that this patients vitals were stable and unremarkable as I took them and when the staff at the nursing home had taken them prior to our arrival. The pt didn't quite remember his medical history (dementia and Alzheimer's)but presented as stable. (Pink warm and dry skin and equal chest rise and fall un labored. And the staff at the nursing home didn't really provide any info (not to try to put blame on anyone but shift change had just happened for them and they are rather unorganized there)

P.s. Sorry i didn't mention he had Alzheimer's in my OP
 

DesertMedic66

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The reality is there are a lot of possibilities. MI, CVA, PE, etc.

With the amount of info you have been able to remember does not provide any help in narrowing it down.
 

Jim37F

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My scientific, wild-*** guess? Some sort of TIA causing the initial AMS/combative mental state that resolved prior to your arrival but led to a full blown fatal stroke later?
 

ERDoc

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Gotcha sorry my post seemed a bit dry in the way of more detailed info. This was a few months ago so the number are foggy for me. But I can say that this patients vitals were stable and unremarkable as I took them and when the staff at the nursing home had taken them prior to our arrival. The pt didn't quite remember his medical history (dementia and Alzheimer's)but presented as stable. (Pink warm and dry skin and equal chest rise and fall un labored. And the staff at the nursing home didn't really provide any info (not to try to put blame on anyone but shift change had just happened for them and they are rather unorganized there)

P.s. Sorry i didn't mention he had Alzheimer's in my OP

The key to this case is right here. He died from nursinghomeshiftchangeitis. It's fairly lethal.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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The key to this case is right here. He died from nursinghomeshiftchangeitis. It's fairly lethal.
Just like priapism is caused by lackanookie.

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EpiEMS

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1)
Pt reported to have backhanded another resident and thrown a metal folding chair at a nurse
jREc5.gif

2) You could have requested a follow-up from the hospital, possibly?
 

hometownmedic5

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Definitely not lupus. It's never lupus

From the information provided, I'm 100% confident in diagnosing this as trypanosomiasis with underlying schistosomiasis causing an acute methane buildup resulting in heavy metal poisining. Or maybe he was just old and boxed. Not every call has an interesting story.

Here's my question. How did you manage to miss your patient going from coherent speech to a GCS of potato in a seven minute ride? I can kind of see a long transport, pt nods off, you elect to let them sleep and they're dead when you get to where you're going. But a <10min ride, talking to dead? How did you lose track of that one?
 

LaAranda

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Here's my question. How did you manage to miss your patient going from coherent speech to a GCS of potato in a seven minute ride? I can kind of see a long transport, pt nods off, you elect to let them sleep and they're dead when you get to where you're going. But a <10min ride, talking to dead? How did you lose track of that one?

One of the great disservices charting provides to our patients.
 

Handsome Robb

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One of the great disservices charting provides to our patients.

You should be able to work on your chart and still pay attention to what is going on in the back of your truck.


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chunkypeaches

chunkypeaches

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Definitely not lupus. It's never lupus

From the information provided, I'm 100% confident in diagnosing this as trypanosomiasis with underlying schistosomiasis causing an acute methane buildup resulting in heavy metal poisining. Or maybe he was just old and boxed. Not every call has an interesting story.

Here's my question. How did you manage to miss your patient going from coherent speech to a GCS of potato in a seven minute ride? I can kind of see a long transport, pt nods off, you elect to let them sleep and they're dead when you get to where you're going. But a <10min ride, talking to dead? How did you lose track of that one?
He was responsive and went under within a one minute window from finishing calling in an encode to the hospital to turning the corner to the facility/ parking. It was a rapid drop. I guess thats why it was so strange to me.
 
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