possible stroke pt

[CTBryan11]

Had a call the other day that came over the radio as possible stroke pt. Of course we went code 3, once on scene fire was already there. Went into the house and had a 89 year old woman that had an altered loc and mumbled speech for about an hour.. vitals were normal.. pt had a history of htn and diabetes.. nothing appeared to be wrong other than the cc.. my medic had me put her on a nc at 5lpm and we loaded her for transport and went to the hospital code one monitoring vitals every 5... my question is I was kinda confused on why my medic didn't perform any stroke test on the pt. Not even the basics such giving a smile or having her close her eyes and hold her arms out to see if one drops w/o the pt realizing it.. didn't even check pupils... after transport I asked why and he stated she's a 89 yr old woman she is gonna have amnesia every now and then.. which I understand but shouldn't at the least some basic test be ran on a possible stroke pt regardless?? Let me know

 

[Amycus]

I'd be interested to know how altered she was, but if someone has a severely altered loc, they likely won't be able to follow the simple instructions of a stroke scale test regardless.

 

[JPINFV]

Please tell me the paramedic at least ruled out hypoglycemia...

 

[Amycus]

Didn't even see the diabetic history thing. I'm going to assume a BGL was a given though =P

 

[CTBryan11]

Her loc was minimal and was alert and able to respond to commands.. that's what made me question it.. she knew where she was.. day and time.. but her speech was extremely slurred and she had no hx of amnesia(stated by daughter)

 

[JPINFV]

Didn't even see the diabetic history thing. I'm going to assume a BGL was a given though =P

A BGL point of care test should be done in any altered patient when available, regardless of history.

 

[CTBryan11]

I did a finger stick after vitals.. bgl was 95

 

[CAOX3]

It your primary hospital a stroke center? If so its possible he did out en-route, all our hospitals are stroke centers, so I will package and do everything en-route vitals, stroke scale, BGL if we can't nail down and onset time. No point pissing through the window if you can do everything en-route especially if I witness them evolving.

 

[CTBryan11]

Primary hospital is a stroke center, but I was able to hear the medic talking to the patient while en-route to the hospital... I never heard any commands that would give a sign to him performing even basic stroke scale test

 

[foxfire]

Pupils? Were they PERRL?

 

[CTBryan11]

Medic didn't check pupils unless he did it in the back of the truck, but.... Once again, never heard him state anything about the pupils

 

[sir.shocksalot]

Sounds like your medic may have dropped the ball. I'm not sure why anyone with a c/c of stoke would not get a stroke scale (or a cranial nerve exam if you're feeling high speed).

I would also like to stress that altered mentation is NEVER a normal finding in the elderly. A lot of physiological things change when we age, but level of consciousness, orientation, and ability to communicate are NOT some of the things that change.

It drives me batty when Paramedics/EMTs say "well she's 85, she is allowed to be a little confused."

 

[CTBryan11]

Thats exactly what I was thinking, I'm not saying my medic is a bad medic because I've worked with him for about 5 months and he is extremely good at what he does... I just didn't agree with how he handled this call.. I'm in medic school right now, and one of my instructors always says, "it's never to late to go back to the basics", which I agree with, and I don't know why my medic didn't run at LEAST some basic stroke test... That same instructor also always says, "when you think you have a call figured out and your comfortable with how your pt is doing and you have everthing figured out, is when you will end up killing someone"... Which I also agree with 100%, hopefully next time my medic will take a little bit more action

 

[yotam]

Sounds life a "too long in this job" syndrom. Symptoms are usually slackyness,
Lack of thoroughness and a burning desire to finish his shift. Etiology is usually working a long time as a medic, no satisfaction from the job etc. Forgive me for saying so, but these guys are the real killers.

Disclaimer: I DO NOT know this guy or how he works, but given the facts that I know it's easy to assume this guys' a burn out. The reason I'm dramatic is that there are just so many of them out there, and I'm becoming more and more aware of these incidents i'm becoming quite worried myself. Whether this was the case or not (and as far as I know your partner might of had a good M.O that we simply missed), don't get there. When the fire's out, it's time to go looking for another fireplace.

 

[SD EMT OPS]

Bgl

I have had a lot of Pt's that presented as CVA that just needed some glucose