What was going on?

[rwik123]

So here's my situation hours ago. I was returning home on the subway at about 11 tonight. Me and my girlfriend are the last off the car and I see a man, head tilted over in his chair. I'm worried he's asleep and won't get off and miss his stop, so I wait while the train director goes over to try waking him up.. No response to verbal, or the man nudging of his foot. I walk over, and tap his shoulder, asking if he can hear me. I then check his airway, clear with shallow respirations.. Fairly weak pulse.. but no sign of alcohol via breath. I then apply about 10 seconds of sternal rub to him. It is then when he snaps to consciousness, and walks out, rather unaware of anything going on, and ignoring the directors questioning, walks zombily away. What in the world was going on? Passed out from alcohol was my guess but there was no hint on his breath.

 

[Shishkabob]

No way to tell at all without a detailed assessment, and even than he might need to be seen at a hospital.




Or he's on prescription meds that make him very lethargic, and was annoyed that people were waking him.

 

[rwik123]

And mods, please move to scenarios, my judgment on forum choice was wrong

 

[rwik123]

No way to tell at all without a detailed assessment, and even than he might need to be seen at a hospital.




Or he's on prescription meds that make him very lethargic, and was annoyed that people were waking him.

The meds thing may be correct. He was questionably homeless, so some kind of drug might have been correct

 

[CAOX3]

Maybe he was sleeping, homeless people sleep on the trains all the time its safer then in some alley.

 

[Jay]

The meds thing may be correct. He was questionably homeless, so some kind of drug might have been correct

So all homeless people are drug addicts?

That bothered me a little bit because I understand where you are coming from as some homeless people become that way because they are not top-shelf members of society, per se, however some have breakdown or are vets with severe PTSD and end up that way not out of choice.

Now that I vented on the social phenomena, I would have to say, given all the facts that this guy was diabetic and currently considering a mild to moderate hypoglycemia as he appeared lethargic and almost intoxicated without the distinct presence of ETOH. The AMS along with the weakened vitals would also back up this theory.

Rx meds is another viable option, did you see his pupils by any chance, if it was Rx meds (somebody elses Rx for example) than the odds are it was some kind of opiate or benzo and he probably would have pinpoint (or at least smaller than average) pupils with delayed reactivity. Remember your opioid triad as he already has respiratory depression and loss of consciousness, the only other thing, which I didn't see anything about was the pupils which should be taken into consideration in the assessment, if pupils were pinpoint the triad would be complete and the odds would point to an opiate overdose.

Finally, perhaps he is narcoleptic and if in decent shape would explain the low resting pulse, this one is more far out than the others but still a possibility, even if not narcoleptic he may have been taking a nap along with a naturally low resting pulse which means that the level of consciousness would have needed to be taken more into consideration in order to determine a proper dx.

Of course there are other things but I would take the evidence into fact and have to side with hypoglycemia or potential overdose (opiate more than likely as per above).

Does anyone else have a take on this?

 

[Hellsbells]

So all homeless people are drug addicts?

No, but a lot are, substance abuse is a huge cause and consequence of homelessness. Of course mental illness is also a common reason, people often turn to drugs to deal with life on the streets. It doesn't seem politically correct, but I can't think of one single homeless person I've met on the job who didn't have a drug or alcohol problem.

 

[CA0X3]

da 'betis!