Public Safety Training Facility

Monroe Community College
Rochester, New York

MCC Paramedic Program Case of the Month 3/98

Dispatch Info: 8:02 AM, Nature: Man unconscious

You arrive to find a 58 yo white male unconscious in his bed. His wife states that he has not felt well for two weeks. She says that he has complained of weakness, being tired, and of intense thirst. He has been urinating more often and has had an increased appetite. The wife says that she has tried to encourage him to go to the doctors office but he never does. She said that last evening he was sleeping on the couch and was hard to arouse when she asked him to retire to the bedroom. This morning she was not able to awaken him. There has been no seizure activity, drug use, or head injury that the wife has observed. He is a cook for a local restaurant. He has not been exposed to any chemicals or illness. He has been previously healthy and does not smoke or drink alcohol. He is not taking any prescription medications and rarely uses OTC meds.

Physical exam: Male patient, appearence consistent with stated age, is found supine on bed, covered to the neck by electric blanket, incontenent of urine, breathing normally but is deeply unconscious.

VS: Pulse 118, Resp 22, BP 108/70, Rectal Temp 37.4

ROS: LOC-Deeply unconscious, no response to deep pain. HEENT-Head:NCAT,Eyes:=@3 mm, gaze conjugate and straight ahead. Ears:WNL. Nose:WNL. Throat:WNL no unusual odor on breath. Tongue no bite marks. CHEST-Clear to auscultation bilaterally. No scars or injuries observed. COR-regular, S1S2 well heard no R/M/G heard. ABD-soft, not distended. EXTREM-equal pulses, no edema. DTR's equal and about +1. SKIN: warm, dry, normal color.

On scene Labs: Blood Oxygen saturation on room air: 98%. Blood Glucose 1200 mg / deciliter. 12 Lead ECG: Sinus Rhythm, QRS axis of 50, QRSI: 0.10, PRI: 0.14, T waves normal, ST segments Isoelectric in all leads.

Based on the history, physical exam, and lab tests your clinical impression is:

(press the blue button)

* Acute Hypoglycemia (insulin shock)

* Diabetic Ketoacidosis

* Coma of unknown etiology

* HHNC (Hyperglycemic hyperosmolar non-ketonic coma)

* CVA (stroke)

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Updated: March 1, 1998