ems-storytime

[ems-storytime]

Context: Me being new advanced, busy city system, working with an experienced basic who knows his stuff.

Dispatch: Unconscious 50s male down in bathroom, hit his head.

We get dispatched sometime in the afternoon, got a fire engine dispatched with us. Forget who was driving doesn't matter, busy day was probably trying to get caught up with charting on the way over. On arrival meet with fire crew, the usually beat us there, haul our equipment and stretcher over to the house. Relative inside says patient essentially has no medical history (specifically denies diabetes history when asked), says patient had been complaining of severe headache all day, went into bathroom, heard him fall, found him lying flat on the floor, not sure if he hit his head. Fire and partner is dealing with patient getting initial vitals, patient is breathing but not alert, tachypneic, forget full vitals it was a while ago but pressure was hypertensive, pulse was kinda normal. C-Collar him, extricate on scoop stretcher onto actual stretcher, get him in my truck. Trauma assessment shows nothing, pupils are normal, breath sounds are clear, I forget what the capno showed, but it was probably low, normal waveform, threw him on a 4-lead, Im not allowed to interpret the danger squiggles but it was totally normal sinus, at some point we throw him on like 2-4L O2 via the capno cuz he was sattin weird and it doesnt hurt. Get a blood sugar, reads High, which on our monitor means over 600. Now at this point both me and my partner are thinking like bad bad head trauma, everything is just screamin head trauma, his breathing is weird his pressure is going up, so we start moving towards the level 2 trauma in the city and call in a stroke alert. Start an IV, dont remember if I started fluids or not.

We get to the hospital, he stays unresponsive throughout, get him to CT, dont get much followup until much later when my partner remembered to ask. Apparently this man had no head trauma he was just experiencing a severe case of Hyperosmolar Hyperglycemic State, which is what most people just think of as "the thing thats not DKA". Still one of the most interesting diabetic presentations I've seen so far, we were both sure he was pretty much dead from a brain bleed, but Im glad he's doing ok.