En Route A paramedic is dispatched to a local convenience st…
En Route A paramedic is dispatched to a local convenience store for an elderly patient who was found alone and confused in the restroom. The time of the call is 1400 on a clear summer afternoon with ambient temperatures exceeding 100F (38C). The region is a medium-sized city with moderate traffic. A stand-alone ED is approximately 8 minutes away, a regional trauma center is 25 minutes away, and an ICU-capable medical center is 15 minutes away with normal traffic. The paramedic is partnered with an EMT in a standard-equipped ALS ambulance. On SceneUpon arrival at the scene, the paramedic was greeted by a store employee who stated that the patient had arrived approximately 30 minutes ago. The patient appeared at that time to be in no distress and filled up a lawn mower and gas cans with no obvious impairment. Store employee stated that the patient entered the restroom normally, however shortly after customers approached staff stating that the patient was slumped over on the toilet, and they were unable to understand anything that the patient was saying. Upon entering the restroom, the paramedic finds the elderly patient seated on the toilet slumped over to the right using the restroom wall to brace themselves. The patient does not respond to the medic entering the room, only looking up when the medic repeatedly addresses them. The patient’s history is unknown. The patient’s skin is pale and diaphoretic. There are no obvious signs of trauma. The patient does not respond appropriately to standard questions and is confused about the events leading up to now. The patient tries to follow commands but is unable to, and they cannot stand or sit independently without falling to the right. Eyes are open, pupils are 5 mm and reactive to light. The vital signs are BP 172/110, P 88, R 20, SpO2 96% on room air. The blood glucose is 100. POST SCENEWhile in route to the hospital, intravenous access is obtained, and the patient is placed on the cardiac monitor. Vital signs at this time are BP 186/112, P 78, RR 16, and SpO2 94% on room air. The following 12-lead ECG is acquired. Further exam reveals clear lung sounds bilaterally, a conjugate gaze to the left with equal and reactive pupils, no cardiac murmurs or gallops, and worsening confusion.